Provider Demographics
NPI:1881229466
Name:LAPPAGE, JENNIFER G
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:LAPPAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 SANDSTONE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-1510
Mailing Address - Country:US
Mailing Address - Phone:281-301-4806
Mailing Address - Fax:
Practice Address - Street 1:3019 SANDSTONE CREEK LN
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-1510
Practice Address - Country:US
Practice Address - Phone:281-301-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79854101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional