Provider Demographics
NPI:1598990814
Name:NOLAN, JENNIFER THOMAS (MED, LPC, LMFT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:THOMAS
Last Name:NOLAN
Suffix:
Gender:F
Credentials:MED, LPC, LMFT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LYONS
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20303 STONE OAK PKWY
Mailing Address - Street 2:APT.7203
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7033
Mailing Address - Country:US
Mailing Address - Phone:225-505-6787
Mailing Address - Fax:
Practice Address - Street 1:20303 STONE OAK PKWY
Practice Address - Street 2:APT.7203
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7033
Practice Address - Country:US
Practice Address - Phone:225-505-6787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-17
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2710101YP2500X
LA675106H00000X
TX75315101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist