Provider Demographics
NPI:1235410945
Name:LAGON, JANINE (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:JANINE
Middle Name:
Last Name:LAGON
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:DR
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:RIOS-DORIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2435 E. SOUTHLAKE BLVD.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:817-657-6277
Mailing Address - Fax:
Practice Address - Street 1:2435 E. SOUTHLAKE BLVD.
Practice Address - Street 2:SUITE 140
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092
Practice Address - Country:US
Practice Address - Phone:817-657-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health