Healthcare Provider Details

I. General information

NPI: 1215590625
Provider Name (Legal Business Name): JENNIFER N ZURI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S MADISON ST
MC GREGOR TX
76657-2328
US

IV. Provider business mailing address

2301 WOODGATE DR APT 515
WACO TX
76712-6740
US

V. Phone/Fax

Practice location:
  • Phone: 254-236-4158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number57588
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: