Provider Demographics
NPI:1477612216
Name:PITMAN, JENNIFER ROSE ANNE (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE ANNE
Last Name:PITMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19206 HUEBNER RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3146
Mailing Address - Country:US
Mailing Address - Phone:210-718-6628
Mailing Address - Fax:210-499-4956
Practice Address - Street 1:19206 HUEBNER RD STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3146
Practice Address - Country:US
Practice Address - Phone:210-718-6628
Practice Address - Fax:210-499-4956
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157555703Medicaid
TX83723LOtherBLUE CROSS BLUE SHIELD