Provider Demographics
NPI:1316340219
Name:VAIL, JESSICA (LCMFT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VAIL
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N WESTMINSTER DR
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-9117
Mailing Address - Country:US
Mailing Address - Phone:316-755-6679
Mailing Address - Fax:
Practice Address - Street 1:207 N WESTMINSTER DR
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9117
Practice Address - Country:US
Practice Address - Phone:316-209-6625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2778106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2778OtherBSRB
KS30004348510001Medicaid