Provider Demographics
NPI:1801287735
Name:GROGAN, JESSICA (PHD, LMFT-A)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GROGAN
Suffix:
Gender:F
Credentials:PHD, LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2009
Mailing Address - Country:US
Mailing Address - Phone:512-993-1616
Mailing Address - Fax:
Practice Address - Street 1:821 W 11TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2009
Practice Address - Country:US
Practice Address - Phone:512-993-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202363106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist