Provider Demographics
NPI:1134295637
Name:DEVINE, JERRY ANTHONY (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:ANTHONY
Last Name:DEVINE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10655 SIX PINES DRIVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380
Mailing Address - Country:US
Mailing Address - Phone:281-296-0088
Mailing Address - Fax:281-296-0513
Practice Address - Street 1:10655 SIX PINES DRIVE
Practice Address - Street 2:SUITE 160
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:281-296-0088
Practice Address - Fax:281-296-0513
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3069106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist