Provider Demographics
NPI:1700191442
Name:JENKINS, STEPHANIE MILLER (MA, LPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MILLER
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 W PANTHER CREEK DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3527
Mailing Address - Country:US
Mailing Address - Phone:281-298-8999
Mailing Address - Fax:
Practice Address - Street 1:4840 W PANTHER CREEK DR
Practice Address - Street 2:SUITE 207
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77381-3527
Practice Address - Country:US
Practice Address - Phone:281-298-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62067101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional