Provider Demographics
NPI:1003355231
Name:SERENITY SOLUTIONS BY JENIFFER
Entity Type:Organization
Organization Name:SERENITY SOLUTIONS BY JENIFFER
Other - Org Name:SERENITY SOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENIFFER
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ESCLOVON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:281-557-6546
Mailing Address - Street 1:4615 SOUTHWEST FREEWAY
Mailing Address - Street 2:860
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027
Mailing Address - Country:US
Mailing Address - Phone:281-557-6546
Mailing Address - Fax:281-764-9461
Practice Address - Street 1:4615 SOUTHWEST FWY
Practice Address - Street 2:860
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7108
Practice Address - Country:US
Practice Address - Phone:281-557-6546
Practice Address - Fax:281-764-9461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14572101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116085502Medicaid