=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104272699
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASANDRA LOURDES OEFFINGER LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2016
-----------------------------------------------------
Last Update Date | 11/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 627 W 19TH ST STE 201
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77008-3658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-268-0979
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 627 W 19TH ST STE 201
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77008-3658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-268-0979
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 72881
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------