Provider Demographics
NPI:1144781535
Name:FENNELL, LAWANDA JEANNETE (LPC-INTERN)
Entity Type:Individual
Prefix:MS
First Name:LAWANDA
Middle Name:JEANNETE
Last Name:FENNELL
Suffix:
Gender:F
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 PAT BOOKER RD STE 204
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-4148
Mailing Address - Country:US
Mailing Address - Phone:210-834-5017
Mailing Address - Fax:
Practice Address - Street 1:1001 PAT BOOKER RD STE 204
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-4148
Practice Address - Country:US
Practice Address - Phone:210-834-5017
Practice Address - Fax:210-855-0931
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65652101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health