Provider Demographics
NPI:1972902187
Name:CORSARO, JESSICA (MA, LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CORSARO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E PLANO PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6746
Mailing Address - Country:US
Mailing Address - Phone:972-978-4668
Mailing Address - Fax:972-805-9396
Practice Address - Street 1:801 E PLANO PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6746
Practice Address - Country:US
Practice Address - Phone:972-978-4668
Practice Address - Fax:972-805-9396
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health