Basic Information
| Provider Information | |||||||||
| NPI: | 1346883972 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANNING | ||||||||
| FirstName: | JENNY | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HARRISON | ||||||||
| OtherFirstName: | JENNY | ||||||||
| OtherMiddleName: | LEIGH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MA, LPC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3331 LUELLA BLVD APT 1307 | ||||||||
| Address2: | |||||||||
| City: | LA PORTE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775713682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138162024 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6021 FAIRMONT PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775054511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817692238 | ||||||||
| FaxNumber: | 2817692164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2019 | ||||||||
| LastUpdateDate: | 10/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 75627 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.