Provider Demographics
NPI:1427872852
Name:FAVATA, JESSICA (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FAVATA
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8463 MEADOW PLNS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2830
Mailing Address - Country:US
Mailing Address - Phone:214-636-3542
Mailing Address - Fax:
Practice Address - Street 1:8463 MEADOW PLNS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-2830
Practice Address - Country:US
Practice Address - Phone:214-636-3542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93755101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional