Provider Demographics
NPI:1538452743
Name:JESSICA ACKER LPC, INC.
Entity type:Organization
Organization Name:JESSICA ACKER LPC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-549-5308
Mailing Address - Street 1:10935 BEN SRENSHAW
Mailing Address - Street 2:STE 100
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935
Mailing Address - Country:US
Mailing Address - Phone:915-549-5308
Mailing Address - Fax:915-881-8788
Practice Address - Street 1:1605 BEECH ST
Practice Address - Street 2:STE A2
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1101
Practice Address - Country:US
Practice Address - Phone:915-549-5308
Practice Address - Fax:915-881-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63041101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201937404Medicaid
TX280611901Medicaid