Most Relevant Information
Provider Data
| NPI Number: | 1003452525 |
| Provider Name: | ELISSA MICHELLE JETER LPC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | 78127 |
Most Important Dates
| Enumeration Date: | 11/19/2019 |
| Last Updated: | 11/19/2019 |
Provider Practice Location
200 S 14TH ST STE 120
MIDLOTHIAN
TX
760653359
Practice Location Phone/Fax
| Phone: | 2142359087 |
| Fax: |
Provider Mailing Location
200 S 14TH ST STE 120
MIDLOTHIAN
TX
760653359
Provider Mailing Phone/Fax
| Phone: | 2142359087 |
| Fax: |