Provider Demographics
NPI:1073678058
Name:KERSH, JEAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:KERSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7272 WURZBACH RD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4801
Mailing Address - Country:US
Mailing Address - Phone:210-615-8880
Mailing Address - Fax:210-615-2279
Practice Address - Street 1:7272 WURZBACH RD
Practice Address - Street 2:SUITE 601
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4801
Practice Address - Country:US
Practice Address - Phone:210-615-8880
Practice Address - Fax:210-615-2279
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13534101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1130726-03Medicaid
TX1130726-02Medicaid