Provider Demographics
NPI:1902645807
Name:BAHENA, JENNY
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:BAHENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 COUNTY ROAD 94 APT 11305
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-2976
Mailing Address - Country:US
Mailing Address - Phone:615-584-4440
Mailing Address - Fax:
Practice Address - Street 1:3800 COUNTY ROAD 94 APT 11305
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-2976
Practice Address - Country:US
Practice Address - Phone:615-584-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94501101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor