Provider Demographics
NPI:1073644886
Name:MITCHELL, JENNIFER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HANKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1067 FM 306 STE 607
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6897
Mailing Address - Country:US
Mailing Address - Phone:830-837-5550
Mailing Address - Fax:
Practice Address - Street 1:1067 FM 360
Practice Address - Street 2:STE 607
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6897
Practice Address - Country:US
Practice Address - Phone:254-744-0317
Practice Address - Fax:830-625-5877
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31742103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158362704Medicaid