Provider Demographics
NPI:1386114452
Name:CARRUTH, JENNA (MS ED; BCBA)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:CARRUTH
Suffix:
Gender:F
Credentials:MS ED; BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 SPENCER CIR
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-5437
Mailing Address - Country:US
Mailing Address - Phone:214-356-3324
Mailing Address - Fax:
Practice Address - Street 1:5133 S FM 549
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-9178
Practice Address - Country:US
Practice Address - Phone:469-548-9021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-13-13783103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst