Provider Demographics
NPI:1356055396
Name:JENNIFER VAN NESS LPC
Entity type:Organization
Organization Name:JENNIFER VAN NESS LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN NESS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:940-487-7240
Mailing Address - Street 1:11122 WURZBACH RD STE 206B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2574
Mailing Address - Country:US
Mailing Address - Phone:940-487-7240
Mailing Address - Fax:
Practice Address - Street 1:11122 WURZBACH RD STE 206B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2574
Practice Address - Country:US
Practice Address - Phone:940-487-7240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1811561533OtherNPI TYPE 1