Provider Demographics
NPI:1508643925
Name:JAVELLANA, JEROME THOMAS (LPC-A)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:THOMAS
Last Name:JAVELLANA
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8122 SPRING CYPRESS RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3123
Mailing Address - Country:US
Mailing Address - Phone:281-210-6677
Mailing Address - Fax:833-536-1725
Practice Address - Street 1:8122 SPRING CYPRESS RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3123
Practice Address - Country:US
Practice Address - Phone:281-210-6677
Practice Address - Fax:833-536-1725
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92753101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional