Provider Demographics
NPI:1396164794
Name:HENDRIXSON, JANIS
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:HENDRIXSON
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 1:2469 RIPPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3679
Mailing Address - Country:US
Mailing Address - Phone:936-273-9790
Mailing Address - Fax:936-273-9790
Practice Address - Street 1:2469 RIPPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-3679
Practice Address - Country:US
Practice Address - Phone:936-273-9790
Practice Address - Fax:936-273-9790
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-12-12092103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst