Healthcare Provider Details

I. General information

NPI: 1689123242
Provider Name (Legal Business Name): JENNIFER TERRY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 CORONA AVE
JASPER AL
35501-5425
US

IV. Provider business mailing address

62 MARTIN OAKS DR
JASPER AL
35504-6981
US

V. Phone/Fax

Practice location:
  • Phone: 205-265-2620
  • Fax: 205-419-8353
Mailing address:
  • Phone: 205-544-1998
  • Fax: 205-419-8353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3875
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number96979
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3875
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number96979
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: