Healthcare Provider Details

I. General information

NPI: 1588847149
Provider Name (Legal Business Name): JANINE HAVARD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANINE AWTREY LPC

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 04/12/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 S MAIN ST
JASPER TX
75951-4739
US

IV. Provider business mailing address

120 ANGELINA ST
ZAVALLA TX
75980-6915
US

V. Phone/Fax

Practice location:
  • Phone: 409-489-1100
  • Fax: 936-238-2092
Mailing address:
  • Phone: 409-489-1100
  • Fax: 936-238-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18076
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18076
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: