Provider Demographics
NPI:1669054631
Name:CARTER, JERALYN DIONNE (PSYD GRADUAND, LMHC)
Entity type:Individual
Prefix:MRS
First Name:JERALYN
Middle Name:DIONNE
Last Name:CARTER
Suffix:
Gender:F
Credentials:PSYD GRADUAND, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4534 RUSSET LEAF TRCE
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-1960
Mailing Address - Country:US
Mailing Address - Phone:806-544-0975
Mailing Address - Fax:
Practice Address - Street 1:4534 RUSSET LEAF TRCE
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-1960
Practice Address - Country:US
Practice Address - Phone:806-544-0975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILMHC-298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health