Provider Demographics
NPI:1720862733
Name:RUSSELL BAKER, JENNIFER DIONNE (LPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DIONNE
Last Name:RUSSELL BAKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16118 BARRELL RUN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5679
Mailing Address - Country:US
Mailing Address - Phone:210-294-3518
Mailing Address - Fax:
Practice Address - Street 1:16118 BARRELL RUN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-5679
Practice Address - Country:US
Practice Address - Phone:210-294-3518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87578101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional