Provider Demographics
NPI:1629231667
Name:HALVERSON, JAYNA M (PH D)
Entity Type:Individual
Prefix:
First Name:JAYNA
Middle Name:M
Last Name:HALVERSON
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SOUTHWESTERN BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3548
Mailing Address - Country:US
Mailing Address - Phone:281-242-1970
Mailing Address - Fax:281-242-1223
Practice Address - Street 1:101 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3668
Practice Address - Country:US
Practice Address - Phone:281-242-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23543103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80670FMedicare PIN