Provider Demographics
NPI:1093009441
Name:RICHARDSON, JANA LEE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:LEE
Last Name:RICHARDSON
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 1:1098 BENTON DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-7907
Mailing Address - Country:US
Mailing Address - Phone:936-671-3358
Mailing Address - Fax:936-639-5710
Practice Address - Street 1:1098 BENTON DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-7907
Practice Address - Country:US
Practice Address - Phone:936-671-3358
Practice Address - Fax:936-639-5710
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional