Provider Demographics
NPI:1053143321
Name:ARCILLA, JEANDELL RIVERA
Entity type:Individual
Prefix:
First Name:JEANDELL
Middle Name:RIVERA
Last Name:ARCILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 COTTAGE GROVE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2980
Mailing Address - Country:US
Mailing Address - Phone:713-725-0910
Mailing Address - Fax:
Practice Address - Street 1:19627 INTERSTATE 45 STE 210
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-6028
Practice Address - Country:US
Practice Address - Phone:281-901-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80513101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health