Provider Demographics
NPI:1053674622
Name:DEITZ, JENNY L (MA, LMFT-A)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:L
Last Name:DEITZ
Suffix:
Gender:F
Credentials:MA, LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15914 BUCCANEER LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-4425
Mailing Address - Country:US
Mailing Address - Phone:281-846-4480
Mailing Address - Fax:
Practice Address - Street 1:15914 BUCCANEER LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-4425
Practice Address - Country:US
Practice Address - Phone:281-846-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201890106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist