Provider Demographics
NPI:1124616545
Name:THOMPSON, JENNA ELISABETH
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ELISABETH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 SAWDUST RD APT 2451
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3387
Mailing Address - Country:US
Mailing Address - Phone:832-691-8035
Mailing Address - Fax:
Practice Address - Street 1:1300 S FRAZIER ST STE 104
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-4410
Practice Address - Country:US
Practice Address - Phone:936-730-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-03
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80283101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor