Provider Demographics
NPI:1972847358
Name:DEANGELIS, JERI ELLEN (MED, LPC)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:ELLEN
Last Name:DEANGELIS
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 MARAVILLAS LOOP
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-1416
Mailing Address - Country:US
Mailing Address - Phone:512-291-7693
Mailing Address - Fax:
Practice Address - Street 1:3939 BEE CAVE RD STE A6
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6429
Practice Address - Country:US
Practice Address - Phone:512-470-6511
Practice Address - Fax:512-291-7693
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13208101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional