Provider Demographics
NPI:1821235862
Name:JETER, DEE ANNA (LPC)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:ANNA
Last Name:JETER
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 1:125 GROVE CRK
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3749
Mailing Address - Country:US
Mailing Address - Phone:254-722-8067
Mailing Address - Fax:
Practice Address - Street 1:125 GROVE CRK
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3749
Practice Address - Country:US
Practice Address - Phone:254-722-8067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14196101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82406LOtherBLUE CROSS/BLUE SHIELD OF TEXAS
TX184888OtherMHN PROFESSIONAL RELATIONS
TX095743302Medicaid
TX823696OtherCHILDREN'S HEALTH INSURANCE PROGRAM