Provider Demographics
NPI:1629144605
Name:EWING, JEANNE A (LCSW, BCD, BAS)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:A
Last Name:EWING
Suffix:
Gender:F
Credentials:LCSW, BCD, BAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 SPACE PARK DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NASSAU BAY
Mailing Address - State:TX
Mailing Address - Zip Code:77058-6304
Mailing Address - Country:US
Mailing Address - Phone:713-503-8061
Mailing Address - Fax:281-218-9277
Practice Address - Street 1:2045 SPACE PARK DR
Practice Address - Street 2:SUITE 250
Practice Address - City:NASSAU BAY
Practice Address - State:TX
Practice Address - Zip Code:77058-6304
Practice Address - Country:US
Practice Address - Phone:713-503-8061
Practice Address - Fax:281-218-9277
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty