Provider Demographics
NPI:1245300706
Name:JENNINGS, LESAJEAN M (PSYD)
Entity type:Individual
Prefix:DR
First Name:LESAJEAN
Middle Name:M
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3938 LUCA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-4022
Mailing Address - Country:US
Mailing Address - Phone:713-747-8136
Mailing Address - Fax:
Practice Address - Street 1:1319 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-4408
Practice Address - Country:US
Practice Address - Phone:713-225-2280
Practice Address - Fax:713-225-5787
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25562103TC0700X
TX30396103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113623601Medicaid