MEDICARE: JENNIFER N STATEN LCSW

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	1041C0700X	Clinical Social Worker	58667	TX

General Provider Information

NPI Number	:	1811507189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER N STATEN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 146
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75483-0146
Country	:	US
Telephone Number	:	903-885-2776
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 MAIN ST
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-3616
Country	:	US
Telephone Number	:	903-885-2776
Fax Number	:

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

Provider Enumeration Date	:	08/03/2020
Last Update Date	:	03/11/2023

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