Provider Demographics
NPI:1285408666
Name:TOM, JESSINA (LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:JESSINA
Middle Name:
Last Name:TOM
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N GORDON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-2373
Mailing Address - Country:US
Mailing Address - Phone:346-347-5265
Mailing Address - Fax:
Practice Address - Street 1:105 N GORDON ST STE 202
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-2373
Practice Address - Country:US
Practice Address - Phone:346-347-5265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86387101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional