Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 13768 | TX |
Y | 101YP2500X | Professional Counselor | 74717 | TX |
NPI | 1003392705 |
---|---|
Provider Name | Jessica Krzyzanowski |
First Address | Houston, TX 77002-2323 |
Second Address | Houston, TX 77002-2323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2018 |
Last Update Date | 16/07/2018 |