Provider Demographics
NPI:1588236418
Name:HOGUE, JASON (PRE-DOCTORAL INTERN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HOGUE
Suffix:
Gender:M
Credentials:PRE-DOCTORAL INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 ROUGHRIDER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:WINDCREST
Mailing Address - State:TX
Mailing Address - Zip Code:78239-2455
Mailing Address - Country:US
Mailing Address - Phone:210-504-4783
Mailing Address - Fax:210-504-4445
Practice Address - Street 1:8100 ROUGHRIDER DR STE 102
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78239-2455
Practice Address - Country:US
Practice Address - Phone:210-504-4783
Practice Address - Fax:210-504-4445
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX88282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program