Provider Demographics
NPI:1225399942
Name:THEIS, JANESE (LCDC)
Entity Type:Individual
Prefix:
First Name:JANESE
Middle Name:
Last Name:THEIS
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 W ALBERTA RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8466
Mailing Address - Country:US
Mailing Address - Phone:956-627-1149
Mailing Address - Fax:
Practice Address - Street 1:3507 W ALBERTA RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8466
Practice Address - Country:US
Practice Address - Phone:956-627-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19398129101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)