Provider Demographics
NPI:1962254813
Name:MAGGARD, JESSE LEVI (MS, LPC)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:LEVI
Last Name:MAGGARD
Suffix:
Gender:M
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 1:3010 SCOTT BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-6803
Mailing Address - Country:US
Mailing Address - Phone:254-773-4022
Mailing Address - Fax:
Practice Address - Street 1:3010 SCOTT BLVD STE 103
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6803
Practice Address - Country:US
Practice Address - Phone:254-855-5462
Practice Address - Fax:281-648-2200
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87173101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional