Provider Demographics
NPI:1245975879
Name:JEFFERSON, AYANA COOLEY
Entity type:Individual
Prefix:
First Name:AYANA
Middle Name:COOLEY
Last Name:JEFFERSON
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 1:11510 ENGLISH ROSE TRL
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-7047
Mailing Address - Country:US
Mailing Address - Phone:832-814-1870
Mailing Address - Fax:
Practice Address - Street 1:2000 S DAIRY ASHFORD RD STE 380
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5733
Practice Address - Country:US
Practice Address - Phone:832-736-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional