Provider Demographics
NPI:1093265704
Name:HAVEMANN, FERNANDA (MA, LPC-INTERN)
Entity Type:Individual
Prefix:
First Name:FERNANDA
Middle Name:
Last Name:HAVEMANN
Suffix:
Gender:F
Credentials:MA, LPC-INTERN
Other - Prefix:MRS
Other - First Name:FERGIE
Other - Middle Name:
Other - Last Name:HAVEMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:25511 BUDDE RD
Mailing Address - Street 2:CAROLINE BUILDING STE 1002
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25511 BUDDE RD
Practice Address - Street 2:CAROLINE BUILDING SUITE 1002
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2080
Practice Address - Country:US
Practice Address - Phone:281-719-5539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional