Provider Demographics
NPI:1639854003
Name:FIERRO, JEANETTE (LPC)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:FIERRO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:VAN HORN
Mailing Address - State:TX
Mailing Address - Zip Code:79855-0594
Mailing Address - Country:US
Mailing Address - Phone:432-703-4011
Mailing Address - Fax:
Practice Address - Street 1:700 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VAN HORN
Practice Address - State:TX
Practice Address - Zip Code:79855-2162
Practice Address - Country:US
Practice Address - Phone:432-283-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87050101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional