Basic Information
| Provider Information | |||||||||
| NPI: | 1073812525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHWARTZ | ||||||||
| FirstName: | JENNA | ||||||||
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| Credential: | MA, LPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 702 GAYTHA CIR APT 1 | ||||||||
| Address2: | |||||||||
| City: | BRYAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778014051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148284770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8441 HIGHWAY 47, CLINICAL BUILDING 1 | ||||||||
| Address2: | SUITE 1100 | ||||||||
| City: | BRYAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9797748200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2011 | ||||||||
| LastUpdateDate: | 01/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.