Provider Demographics
NPI:1336982503
Name:DE LEON, JESENIA CHRISTIANN
Entity type:Individual
Prefix:
First Name:JESENIA
Middle Name:CHRISTIANN
Last Name:DE LEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9334 REDFISH
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-5314
Mailing Address - Country:US
Mailing Address - Phone:210-954-4237
Mailing Address - Fax:
Practice Address - Street 1:9334 REDFISH
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-5314
Practice Address - Country:US
Practice Address - Phone:210-954-4237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-348297106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician