Provider Information for 1225415706
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JESSICA PUSTKA Lpc-S
Sex: Female
NPI: 1225415706
Last Updated: 2023-09-28
Certification Date: 2023-09-28
Certification Date: 2023-09-28
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1225415706 | ||||||||||||
| Enumeration Date | 2015-05-04 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 132 HEMATITE LN JARRELL, TX 76537-1844 United States Phone: 512-826-9042 | Fax: | ||||||||||||
| Primary Practice Address | 2025 MEMORY LN STE 500 HARKER HEIGHTS, TX 76548-7489 United States Phone: 512-826-9042 | Fax: | ||||||||||||
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