Provider Demographics
NPI:1922540624
Name:DEYNE, JENNIFER (M ED, LPC-S, LSOTP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DEYNE
Suffix:
Gender:F
Credentials:M ED, LPC-S, LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 N SAM HOUSTON PKWY E
Mailing Address - Street 2:SUITE 610
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-3600
Mailing Address - Country:US
Mailing Address - Phone:281-387-6332
Mailing Address - Fax:
Practice Address - Street 1:3663 N SAM HOUSTON PKWY E
Practice Address - Street 2:SUITE 610
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-3600
Practice Address - Country:US
Practice Address - Phone:281-387-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional