Provider Demographics
NPI:1023367075
Name:TAMEZ, JEANNINE PAOLA (PHD)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:PAOLA
Last Name:TAMEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3918 PENNYOAK DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-2525
Mailing Address - Country:US
Mailing Address - Phone:832-341-6342
Mailing Address - Fax:
Practice Address - Street 1:3918 PENNYOAK DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-2525
Practice Address - Country:US
Practice Address - Phone:832-341-6342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36284103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36284OtherTEXAS STATE BOARD EXAMINERS OF PSYCHOLOGISTS