Healthcare Provider Details

I. General information

NPI: 1013631886
Provider Name (Legal Business Name): JENNIFER MASSMAN IHP HEALTH COACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 SUSSEX DR
AUSTIN TX
78745-2415
US

IV. Provider business mailing address

812 SUSSEX DR
AUSTIN TX
78745-2415
US

V. Phone/Fax

Practice location:
  • Phone: 817-988-0127
  • Fax:
Mailing address:
  • Phone: 817-988-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: