Provider Demographics
NPI:1548678899
Name:LOCUSON, JESSICA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:LOCUSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:NEWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:15250 QUORUM DR APT 165
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4620
Mailing Address - Country:US
Mailing Address - Phone:469-844-0112
Mailing Address - Fax:
Practice Address - Street 1:15250 QUORUM DR APT 165
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4620
Practice Address - Country:US
Practice Address - Phone:469-844-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0194431041C0700X
TX1033111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW019443OtherLCSW