Provider Demographics
NPI:1760249361
Name:HENNESEY, ETHAN SHANE (LPC-S)
Entity Type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:SHANE
Last Name:HENNESEY
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-4010
Mailing Address - Country:US
Mailing Address - Phone:281-726-3027
Mailing Address - Fax:
Practice Address - Street 1:406 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-4010
Practice Address - Country:US
Practice Address - Phone:281-726-3027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health