Provider Demographics
NPI:1508464405
Name:CREED, JESSICA (BCABA, LABA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CREED
Suffix:
Gender:F
Credentials:BCABA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8438 SILVER BRUSH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5741
Mailing Address - Country:US
Mailing Address - Phone:312-613-8433
Mailing Address - Fax:
Practice Address - Street 1:12770 CIMARRON PATH # 127
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3427
Practice Address - Country:US
Practice Address - Phone:312-613-8433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst