Provider Demographics
NPI:1083950844
Name:JANZEN, BERNADINE (LPC)
Entity Type:Individual
Prefix:
First Name:BERNADINE
Middle Name:
Last Name:JANZEN
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 1:5802 BOB BULLOCK LOOP STE C1
Mailing Address - Street 2:APT. 328C-101
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-8813
Mailing Address - Country:US
Mailing Address - Phone:387-761-0360
Mailing Address - Fax:888-845-9302
Practice Address - Street 1:5802 BOB BULLOCK LOOP STE C1
Practice Address - Street 2:APT. 328C-101
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-8813
Practice Address - Country:US
Practice Address - Phone:387-761-0360
Practice Address - Fax:888-845-9302
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK410101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional