Provider Demographics
NPI:1215952973
Name:CASS, JENNIFER CLAUDETTE (MA LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CLAUDETTE
Last Name:CASS
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:CLAUDETTE
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LPC
Mailing Address - Street 1:113 N SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028
Mailing Address - Country:US
Mailing Address - Phone:817-295-9411
Mailing Address - Fax:817-295-7815
Practice Address - Street 1:113 N SCOTT ST
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028
Practice Address - Country:US
Practice Address - Phone:817-295-9411
Practice Address - Fax:817-295-7815
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX237743OtherAMERIGROUP
TX10013014OtherAMERIGROUP
TX7551645OtherAETNA