Provider Demographics
NPI:1558998377
Name:SHIELDS, JENNY
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:
Last Name:SHIELDS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 TECHNOLOGY FOREST PL STE 175
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1183
Mailing Address - Country:US
Mailing Address - Phone:713-482-1925
Mailing Address - Fax:
Practice Address - Street 1:8708 TECHNOLOGY FOREST PL STE 175
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-1183
Practice Address - Country:US
Practice Address - Phone:713-482-1925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40268103TC0700X, 103TH0100X
OK1359103TH0100X
TX129889174V00000X
OK129889174V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No174V00000XOther Service ProvidersClinical Ethicist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1558998377Medicaid