Provider Demographics
NPI:1861775322
Name:FELDMAN, JESSICA ALICE (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ALICE
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ALICE
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2065 TAWLEED RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4322
Mailing Address - Country:US
Mailing Address - Phone:775-830-5377
Mailing Address - Fax:
Practice Address - Street 1:6490 S MCCARRAN BLVD STE 6
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6165
Practice Address - Country:US
Practice Address - Phone:775-448-9760
Practice Address - Fax:775-448-9761
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7040-C101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health