Provider Demographics
NPI:1821663048
Name:WALLACE-LENNOX, JANNA (LMFT)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:
Last Name:WALLACE-LENNOX
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ELLIS POND CT
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76085-1650
Mailing Address - Country:US
Mailing Address - Phone:661-860-2189
Mailing Address - Fax:
Practice Address - Street 1:4203 WOODCOCK DR STE 216
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1312
Practice Address - Country:US
Practice Address - Phone:210-564-9116
Practice Address - Fax:210-564-9087
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12844106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist