Provider Demographics
NPI:1386305167
Name:ANDERSON, JENNIFER DITTRICH (LMFT, LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DITTRICH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:RENEE
Other - Last Name:DITTRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2706 CARMEL WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-1557
Mailing Address - Country:US
Mailing Address - Phone:713-578-0474
Mailing Address - Fax:
Practice Address - Street 1:102 E WALKER ST STE 102C
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3803
Practice Address - Country:US
Practice Address - Phone:713-578-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88745101YM0800X
TX204349106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health