Provider Demographics
NPI:1265712962
Name:HENN, JEREMY (PHD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:HENN
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 1:5441 BABCOCK RD
Mailing Address - Street 2:PLAZA LECEA, SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3993
Mailing Address - Country:US
Mailing Address - Phone:210-694-6225
Mailing Address - Fax:210-694-6280
Practice Address - Street 1:5441 BABCOCK RD
Practice Address - Street 2:PLAZA LECEA, SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3993
Practice Address - Country:US
Practice Address - Phone:210-694-6225
Practice Address - Fax:210-694-6280
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001324103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical