Provider Demographics
NPI:1629747845
Name:HINES, JEANNE MORRIS (PLP,LSSP)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:MORRIS
Last Name:HINES
Suffix:
Gender:F
Credentials:PLP,LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W BAKER RD STE 2116
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2306
Mailing Address - Country:US
Mailing Address - Phone:409-549-0218
Mailing Address - Fax:
Practice Address - Street 1:109 S HARRIS ST STE 125A
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6083
Practice Address - Country:US
Practice Address - Phone:972-772-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70801103TS0200X
TX38661103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool