Provider Demographics
NPI:1376560359
Name:BISSETT, JENNIFER LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:BISSETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:RICHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2431
Mailing Address - Country:US
Mailing Address - Phone:281-332-5100
Mailing Address - Fax:281-332-5155
Practice Address - Street 1:216 N MICHIGAN AVE
Practice Address - Street 2:SUITE 585
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2431
Practice Address - Country:US
Practice Address - Phone:281-332-5100
Practice Address - Fax:281-332-5155
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3-2445103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX614295OtherVALUEOPTIONS
TX176347603Medicaid
TX8G0983OtherBCBS
TX87499AOtherBCBS
TX8G0983Medicare ID - Type UnspecifiedMCARE
TX176347603Medicaid