Individual
DEE ANNA JETER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
125 GROVE CRK, WACO, TX 76708-3749
(254) 722-8067
Mailing address
125 GROVE CRK, WACO, TX 76708-3749
(254) 722-8067
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
14196
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
095743302
—
TX
01
—
184888
MHN PROFESSIONAL RELATIONS
TX
01
—
823696
CHILDREN'S HEALTH INSURANCE PROGRAM
TX
01
—
82406L
BLUE CROSS/BLUE SHIELD OF TEXAS
TX
Enumeration date
01/13/2009
Last updated
07/29/2015
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