Provider Demographics
NPI:1811037914
Name:GENUNG, VANESSA M (PHD FPMHNP RNCS APRN)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:M
Last Name:GENUNG
Suffix:
Gender:F
Credentials:PHD FPMHNP RNCS APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W HARWOOD RD
Mailing Address - Street 2:#250
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054
Mailing Address - Country:US
Mailing Address - Phone:817-581-1049
Mailing Address - Fax:817-428-6380
Practice Address - Street 1:720 W HARWOOD RD
Practice Address - Street 2:#250
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054
Practice Address - Country:US
Practice Address - Phone:817-581-1049
Practice Address - Fax:817-428-6380
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX096301041C0700X
TX2122106H00000X
TX543296363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSW00595J2Medicaid
TXSW00595J2Medicaid