Provider Demographics
NPI:1386255792
Name:PRIESTLEY, JESSICA JO (LPCC NCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JO
Last Name:PRIESTLEY
Suffix:
Gender:F
Credentials:LPCC NCC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:JO
Other - Last Name:VINCENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 ROACH ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9393
Mailing Address - Country:US
Mailing Address - Phone:502-863-4734
Mailing Address - Fax:
Practice Address - Street 1:110 ROACH ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9393
Practice Address - Country:US
Practice Address - Phone:502-863-4734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY287977101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid