Provider Demographics
NPI:1053665281
Name:JENNIFER L. ROCKETT, PH.D.
Entity Type:Organization
Organization Name:JENNIFER L. ROCKETT, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:979-450-5320
Mailing Address - Street 1:PO BOX 9276
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77842-9276
Mailing Address - Country:US
Mailing Address - Phone:979-450-5320
Mailing Address - Fax:979-713-1245
Practice Address - Street 1:2402 BROADMOOR DR
Practice Address - Street 2:BUILDING DII SUITE 111
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2847
Practice Address - Country:US
Practice Address - Phone:979-450-5320
Practice Address - Fax:979-713-1245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36024103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty