Healthcare Provider Details

I. General information

NPI: 1649510694
Provider Name (Legal Business Name): JENIFFER KAY ESCLOVON MED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 WEST LOOP S STE 110
BELLAIRE TX
77401-2919
US

IV. Provider business mailing address

6300 WEST LOOP S STE 110
BELLAIRE TX
77401-2919
US

V. Phone/Fax

Practice location:
  • Phone: 409-626-1329
  • Fax: 832-852-5754
Mailing address:
  • Phone: 409-626-1329
  • Fax: 832-852-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14572
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14572
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: