Provider Demographics
NPI:1356443824
Name:JETER, M. ELIZABETH (LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:M.
Middle Name:ELIZABETH
Last Name:JETER
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8203 WILLOW PLACE DR S
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5655
Mailing Address - Country:US
Mailing Address - Phone:281-955-5055
Mailing Address - Fax:281-897-0825
Practice Address - Street 1:8203 WILLOW PLACE DR S
Practice Address - Street 2:SUITE 150
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5655
Practice Address - Country:US
Practice Address - Phone:281-955-5055
Practice Address - Fax:281-897-0825
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1848106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6800LCOtherBCBS PROVIDER #
TX8793OtherSTATE LPC LICENSE