Provider Demographics
NPI:1659131324
Name:DALEY, JENNAH (MS, LMFT-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:JENNAH
Middle Name:
Last Name:DALEY
Suffix:
Gender:F
Credentials:MS, LMFT-ASSOCIATE
Other - Prefix:
Other - First Name:JENNAH
Other - Middle Name:
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3222 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2166
Mailing Address - Country:US
Mailing Address - Phone:928-733-7425
Mailing Address - Fax:
Practice Address - Street 1:5504 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-4137
Practice Address - Country:US
Practice Address - Phone:928-733-7425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205455106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist