Provider Demographics
NPI:1871894535
Name:JEFFERSON, REGINALD GERARD (NCC, LPC, LMFTA)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:GERARD
Last Name:JEFFERSON
Suffix:
Gender:M
Credentials:NCC, LPC, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24034 ROCKIN SEVEN DR
Mailing Address - Street 2:
Mailing Address - City:HOCKLEY
Mailing Address - State:TX
Mailing Address - Zip Code:77447-9201
Mailing Address - Country:US
Mailing Address - Phone:281-373-0105
Mailing Address - Fax:
Practice Address - Street 1:24034 ROCKIN SEVEN DR
Practice Address - Street 2:
Practice Address - City:HOCKLEY
Practice Address - State:TX
Practice Address - Zip Code:77447-9201
Practice Address - Country:US
Practice Address - Phone:281-373-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65190101YM0800X, 101YP2500X
TX201412106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist