Provider Demographics
NPI:1508562513
Name:UTLEY, JESSICA LYNNE (LPC, LCPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:UTLEY
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 RIDGE RD STE 101-1100
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6670
Mailing Address - Country:US
Mailing Address - Phone:469-457-4929
Mailing Address - Fax:
Practice Address - Street 1:550 S WATTERS RD
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5223
Practice Address - Country:US
Practice Address - Phone:469-457-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7571962101YP2500X
TX86018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX38033688OtherTEXAS DRIVERS LICENSE