Provider Demographics
NPI:1720728108
Name:DURHAM, JESSICA (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7806 AUTUMN HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-1250
Mailing Address - Country:US
Mailing Address - Phone:936-230-8077
Mailing Address - Fax:
Practice Address - Street 1:5901 LONG DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-1003
Practice Address - Country:US
Practice Address - Phone:832-778-9432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
81283101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional