Provider Demographics
NPI:1861927261
Name:SIAS, JESSE (LCSW)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:SIAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3628 NORTHCREST DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76031-7925
Mailing Address - Country:US
Mailing Address - Phone:817-357-6309
Mailing Address - Fax:
Practice Address - Street 1:3628 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76031-7925
Practice Address - Country:US
Practice Address - Phone:817-357-6309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX563981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical