Provider Demographics
NPI:1023357167
Name:JENNINGS, KRISTINA M (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 REGENCY PKWY
Mailing Address - Street 2:SUITE #601
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3794
Mailing Address - Country:US
Mailing Address - Phone:409-363-3469
Mailing Address - Fax:817-539-0498
Practice Address - Street 1:305 REGENCY PKWY
Practice Address - Street 2:SUITE #601
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3794
Practice Address - Country:US
Practice Address - Phone:409-363-3469
Practice Address - Fax:817-539-0498
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-09
Last Update Date:2013-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional