Healthcare Provider Details

I. General information

NPI: 1316403546
Provider Name (Legal Business Name): JENNIFER ANN PEEVEY M.ED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6104 US HIGHWAY 83
SHAMROCK TX
79079-6924
US

IV. Provider business mailing address

6104 US HIGHWAY 83
SHAMROCK TX
79079-6924
US

V. Phone/Fax

Practice location:
  • Phone: 806-216-1021
  • Fax:
Mailing address:
  • Phone: 806-216-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number77789
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: