Provider Demographics
NPI:1386331056
Name:BUCKHALTER, JENIKA (LMSW)
Entity type:Individual
Prefix:
First Name:JENIKA
Middle Name:
Last Name:BUCKHALTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 N ELDRIDGE PKWY APT 403
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2745
Mailing Address - Country:US
Mailing Address - Phone:901-376-3344
Mailing Address - Fax:
Practice Address - Street 1:875 N ELDRIDGE PKWY APT 403
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2745
Practice Address - Country:US
Practice Address - Phone:901-376-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106496104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker