Healthcare Provider Details

I. General information

NPI: 1467809053
Provider Name (Legal Business Name): JENNIFER LYNN SHIRLEY LMHC, LPC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN ANDERSON LMHC, CRC

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

569 MAIN ST
WARREN RI
02885-4356
US

IV. Provider business mailing address

20 HEARTHSTONE DR
HEBRON CT
06248-1202
US

V. Phone/Fax

Practice location:
  • Phone: 401-903-0324
  • Fax:
Mailing address:
  • Phone: 401-903-0324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01054
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number006960
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00233417
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: