Provider Demographics
NPI:1720350374
Name:INNIS, NANCY I (LPC-S)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:I
Last Name:INNIS
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 VALLEY RANCH PKWY E
Mailing Address - Street 2:SUITE 2039
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4730
Mailing Address - Country:US
Mailing Address - Phone:817-903-1696
Mailing Address - Fax:
Practice Address - Street 1:9901 VALLEY RANCH PKWY E
Practice Address - Street 2:SUITE 2039
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4730
Practice Address - Country:US
Practice Address - Phone:817-903-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-29
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13221101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional