Provider Demographics
NPI:1366155657
Name:WILCOX, JESSICA C (LMHC-P)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:C
Last Name:WILCOX
Suffix:
Gender:F
Credentials:LMHC-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MASSACHUSETTS ST
Mailing Address - Street 2:
Mailing Address - City:NUNDA
Mailing Address - State:NY
Mailing Address - Zip Code:14517-9406
Mailing Address - Country:US
Mailing Address - Phone:585-808-4411
Mailing Address - Fax:
Practice Address - Street 1:61 MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1246
Practice Address - Country:US
Practice Address - Phone:585-204-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-P119672-01101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18-P119672-01OtherNEW YORK STATE PERMIT