Healthcare Provider Details

I. General information

NPI: 1871894535
Provider Name (Legal Business Name): REGINALD GERARD JEFFERSON NCC, LPC, LMFTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24034 ROCKIN SEVEN DR
HOCKLEY TX
77447-9201
US

IV. Provider business mailing address

24034 ROCKIN SEVEN DR
HOCKLEY TX
77447-9201
US

V. Phone/Fax

Practice location:
  • Phone: 281-373-0105
  • Fax:
Mailing address:
  • Phone: 281-373-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number65190
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number65190
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number201412
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: