Provider Demographics
NPI:1548923725
Name:SEWARD, JALISA
Entity type:Individual
Prefix:
First Name:JALISA
Middle Name:
Last Name:SEWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17111 HAFER RD APT 823
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3923
Mailing Address - Country:US
Mailing Address - Phone:815-981-1324
Mailing Address - Fax:
Practice Address - Street 1:8505 JACKRABBIT RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-3009
Practice Address - Country:US
Practice Address - Phone:346-340-7182
Practice Address - Fax:866-257-7696
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician