Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 78127 | TX |
NPI | 1003452525 |
---|---|
Provider Name | Elissa Michelle Jeter |
First Address | Midlothian, TX 76065-3359 |
Second Address | Midlothian, TX 76065-3359 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2019 |
Last Update Date | 19/11/2019 |