Jessica Dianne Licht

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-22-58490 Issued in GA

Practice address

2227 Godby Rd
Atlanta, GA 30349-5020

Phone

(855) 772-8847

NPI assigned

Feb 17, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Jessica Dianne Kelly Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Blossom Center for Children LLC

  • Behavior Analyst
  • San Antonio, TX
  • NPI 1881991990
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758067200000",
    "number": "1396245262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27777 INKSTER RD STE 100",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483345312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2227 GODBY RD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303495020",
            "telephone_number": "855-772-8847"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 N Loop 1604 E",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782321268",
            "country_code": "US",
            "telephone_number": "210-239-0066",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 N Loop 1604 E",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782321268",
            "country_code": "US",
            "telephone_number": "210-239-0066",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "126 Pavilion Parkway",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "GA",
            "postal_code": "302141268",
            "country_code": "US",
            "telephone_number": "770-954-8988",
            "fax_number": "317-520-8200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14235 Blanco Rd",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782167718",
            "country_code": "US",
            "telephone_number": "210-415-9626",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LICHT",
        "first_name": "JESSICA",
        "middle_name": "DIANNE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-17",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "GA",
            "license": "1-22-58490",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "TX",
            "license": "4962",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "KELLY",
            "middle_name": "DIANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Liberty Medical DME, LLC
• Libertycare Tranportation LLC
• Dana Libman, AUD
• Meredith Licalzi, MD
• Skylar Elayne Lichkay, AGACNP-BC
• Jay Leonard Lichtenfeld, MD
• Jason Barry Lichtenstein, MD
• Bailee Marie Lichter, MD
• Eric Lichtfuss Jr., PAA
• Giancarlo Licitra, MD

• Behavior Analyst in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Behavior Analyst in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.