Provider Demographics
NPI:1669909636
Name:ANSELMO-HENSON, JANET
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:ANSELMO-HENSON
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 1:4848 PEMBERTON LN
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2066
Mailing Address - Country:US
Mailing Address - Phone:682-241-2564
Mailing Address - Fax:
Practice Address - Street 1:2418 MARSH LN STE 104
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-3342
Practice Address - Country:US
Practice Address - Phone:682-241-2564
Practice Address - Fax:682-241-2564
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-21
Last Update Date:2017-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5133101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)