Provider Demographics
NPI:1427823681
Name:JENNINGS, PORSHA NICOLE (RBT)
Entity type:Individual
Prefix:
First Name:PORSHA
Middle Name:NICOLE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 N SAM HOUSTON PKWY E STE 110
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-5141
Mailing Address - Country:US
Mailing Address - Phone:832-412-1787
Mailing Address - Fax:
Practice Address - Street 1:555 SEMINAR DR APT 59
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-1516
Practice Address - Country:US
Practice Address - Phone:832-939-0622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician