1023769411 NPI number — JENNY BEATRIZ HENSON MS, LPC, LCDC

Table of content: JENNY BEATRIZ HENSON MS, LPC, LCDC (NPI 1023769411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023769411 NPI number — JENNY BEATRIZ HENSON MS, LPC, LCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENSON
Provider First Name:
JENNY
Provider Middle Name:
BEATRIZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC, LCDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023769411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1991 NW COUNTY ROAD 0020
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORSICANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75110-2179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-654-9147
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 W 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORSICANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75110-3012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-872-4443
Provider Business Practice Location Address Fax Number:
903-872-2125
Provider Enumeration Date:
01/17/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 84155 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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