Provider Demographics
NPI:1245076439
Name:JEANISE, HANNAH RAE (LMSW)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:RAE
Last Name:JEANISE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:RAE
Other - Last Name:MONTOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:417 BREES BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4827
Mailing Address - Country:US
Mailing Address - Phone:210-488-2960
Mailing Address - Fax:
Practice Address - Street 1:11901 TOEPPERWEIN RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3161
Practice Address - Country:US
Practice Address - Phone:210-951-3479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112655104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty