Provider Demographics
NPI:1235244641
Name:HOGAN, JALYNN (LCSW, LMFT)
Entity Type:Individual
Prefix:
First Name:JALYNN
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10008 W COUNTY ROAD 116
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-2615
Mailing Address - Country:US
Mailing Address - Phone:432-563-4144
Mailing Address - Fax:432-561-8611
Practice Address - Street 1:10008 W COUNTY ROAD 116
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-2615
Practice Address - Country:US
Practice Address - Phone:432-563-4144
Practice Address - Fax:432-561-8611
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11888101Y00000X, 104100000X, 1041C0700X
TX1678106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123660OtherSUPERIOR HEALTH PLAN
TX064185402OtherTMHP
TX0641854-02Medicaid
TX5145094OtherAETNA
TX87362QOtherBCBS INDIVIDUAL
TXOOT37AOtherBCBS