Provider Demographics
NPI:1639655814
Name:BOUCHER, JENNIE HEINZE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:HEINZE
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:
Other - Last Name:HEINZE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:5629 FM 1960 RD W STE 231
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4215
Mailing Address - Country:US
Mailing Address - Phone:713-898-1752
Mailing Address - Fax:
Practice Address - Street 1:5629 FM 1960 RD W STE 231
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4215
Practice Address - Country:US
Practice Address - Phone:713-898-1752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74925101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty