Provider Demographics
NPI:1366787160
Name:GELGAND-VALENCIA, JESSICA C (LMFT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:C
Last Name:GELGAND-VALENCIA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13706 RESEARCH BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1838
Mailing Address - Country:US
Mailing Address - Phone:575-640-3112
Mailing Address - Fax:
Practice Address - Street 1:13706 RESEARCH BLVD STE 114
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1838
Practice Address - Country:US
Practice Address - Phone:575-640-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202716101YM0800X
NM0177771106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM74481Medicaid
NM85-0204142OtherMEDICARE
NM47043Medicaid