Provider Demographics
NPI:1932592649
Name:CANTRELL, JESSICA (MA, LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:358 MEADOW WOOD DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2041
Mailing Address - Country:US
Mailing Address - Phone:636-465-9006
Mailing Address - Fax:
Practice Address - Street 1:508 N TRUMAN BLVD STE H
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019-1344
Practice Address - Country:US
Practice Address - Phone:636-465-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MO2015013402101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator