Provider Demographics
NPI:1124467170
Name:BARRANCO, JENNIFER THERESA (LPC, LSSP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:THERESA
Last Name:BARRANCO
Suffix:
Gender:F
Credentials:LPC, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11609 PRINCESS ANN CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-3605
Mailing Address - Country:US
Mailing Address - Phone:832-797-1178
Mailing Address - Fax:
Practice Address - Street 1:11609 PRINCESS ANN CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-3605
Practice Address - Country:US
Practice Address - Phone:832-797-1178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62987101YP2500X
TX34196103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool