Healthcare Provider Details

I. General information

NPI: 1942509740
Provider Name (Legal Business Name): JENNIFER LAURICH MA, LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 SW 45TH AVE STE 19
AMARILLO TX
79109-5078
US

IV. Provider business mailing address

PO BOX 20541
AMARILLO TX
79114-2541
US

V. Phone/Fax

Practice location:
  • Phone: 806-676-6876
  • Fax:
Mailing address:
  • Phone: 806-676-6876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number65499
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: