MEDICARE: JENNIFER HUBBARD LPC ASSOCIATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	84844	TX

General Provider Information

NPI Number	:	1689338634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HUBBARD LPC ASSOCIATE

Provider Business Mailing Address
First Line	:	5457 RICHARD AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-6713
Country	:	US
Telephone Number	:	803-479-5096
Fax Number	:

Provider Business Practice Location Address
First Line	:	4849 GREENVILLE AVE STE 1675
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-4153
Country	:	US
Telephone Number	:	214-886-5760
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2021
Last Update Date	:	10/26/2021

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