Provider Demographics
NPI:1639704034
Name:WEINSTEIN, JENINE C
Entity Type:Individual
Prefix:
First Name:JENINE
Middle Name:C
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11925 SOUTHWEST FWY STE 5
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2300
Mailing Address - Country:US
Mailing Address - Phone:832-460-5121
Mailing Address - Fax:281-271-9085
Practice Address - Street 1:11925 SOUTHWEST FWY STE 5
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2300
Practice Address - Country:US
Practice Address - Phone:832-460-5121
Practice Address - Fax:281-271-9085
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-19-90651106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician