Provider Demographics
NPI:1558908327
Name:RANKINS, JEREMY JERMEL (LPC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:JERMEL
Last Name:RANKINS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11811 NORTH FWY STE 500
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3287
Mailing Address - Country:US
Mailing Address - Phone:281-972-8383
Mailing Address - Fax:281-972-8285
Practice Address - Street 1:11811 NORTH FWY STE 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3287
Practice Address - Country:US
Practice Address - Phone:281-972-8383
Practice Address - Fax:281-972-8285
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-29
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80543101Y00000X, 101YP2500X, 101YM0800X
80543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX850729561Medicaid