Provider Demographics
NPI:1942406236
Name:JAGERS, J. LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:LEE
Last Name:JAGERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W CAMPBELL RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3601
Mailing Address - Country:US
Mailing Address - Phone:972-671-3200
Mailing Address - Fax:972-671-3102
Practice Address - Street 1:275 W CAMPBELL RD
Practice Address - Street 2:SUITE 121
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3601
Practice Address - Country:US
Practice Address - Phone:972-671-3200
Practice Address - Fax:972-671-3102
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4753101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional