Provider Demographics
NPI:1770329922
Name:CHANG, JENNA (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5724 91ST ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-4568
Mailing Address - Country:US
Mailing Address - Phone:832-659-1049
Mailing Address - Fax:
Practice Address - Street 1:5504 WAYNE AVE STE 102
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-4137
Practice Address - Country:US
Practice Address - Phone:806-491-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203030106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist