Healthcare Provider Details

I. General information

NPI: 1861327686
Provider Name (Legal Business Name): JENNIFER SKURA MA, MFA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER BOUTELL

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E BROAD ST
NEWNAN GA
30263-1922
US

IV. Provider business mailing address

220 ADAIR ST APT 12
DECATUR GA
30030-2968
US

V. Phone/Fax

Practice location:
  • Phone: 404-590-2866
  • Fax:
Mailing address:
  • Phone: 917-502-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: