Provider Demographics
NPI:1770592966
Name:STREIT-HORN, JENNIFER (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:STREIT-HORN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:STREIT-HORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:207 W HICKORY ST STE 207
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4150
Mailing Address - Country:US
Mailing Address - Phone:940-367-8383
Mailing Address - Fax:940-591-9154
Practice Address - Street 1:207 W HICKORY ST STE 207
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4150
Practice Address - Country:US
Practice Address - Phone:940-367-8383
Practice Address - Fax:940-591-9154
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17155101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155070901Medicaid