Provider Demographics
NPI:1679292528
Name:VENTURA, JESSICA ROSE (LPC, LPCMH (DE), NCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE
Last Name:VENTURA
Suffix:
Gender:F
Credentials:LPC, LPCMH (DE), NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W LINCOLN HWY STE 40
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2521
Mailing Address - Country:US
Mailing Address - Phone:484-402-6017
Mailing Address - Fax:
Practice Address - Street 1:407 W LINCOLN HWY STE 40
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2521
Practice Address - Country:US
Practice Address - Phone:484-402-6027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011700101YP2500X
PAPC014643101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional