MEDICARE: MS. JENNIFER DENITRA POPOVICH LPC, NCC, CDWF, MAC

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	101Y00000X	Counselor	69812	TX
2	101YP2500X	Professional Counselor	69812	TX

General Provider Information

NPI Number	:	1801298344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER DENITRA POPOVICH LPC, NCC, CDWF, MAC

Provider Business Mailing Address
First Line	:	1205 N HIGHWAY 123
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-7756
Country	:	US
Telephone Number	:	512-230-9103
Fax Number	:	512-858-9620

Provider Business Practice Location Address
First Line	:	1205 N HIGHWAY 123
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-7756
Country	:	US
Telephone Number	:	512-230-9103
Fax Number	:	512-858-9620

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

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	01/03/2023

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