Provider Demographics
NPI:1215130026
Name:JAIN, SAUNDRA L (PSYD, LPC)
Entity type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:L
Last Name:JAIN
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:SAUNDRA
Other - Middle Name:L
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:19 HERITAGE OAK CT
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4961
Mailing Address - Country:US
Mailing Address - Phone:979-480-9886
Mailing Address - Fax:979-480-9997
Practice Address - Street 1:201 OAK DR S
Practice Address - Street 2:SUITE 204
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5676
Practice Address - Country:US
Practice Address - Phone:979-480-9886
Practice Address - Fax:979-480-9997
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional