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General NPI Number Information
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NPI Number | 1194317453
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Entity Type | Organization
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Legal Business Name | JEPPSEN ENTERPRISES
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 4321 BOULEVARD PARK S
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City | MOBILE
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State | AL
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Zip | 36609-3404
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Country | US
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Telephone | 479-981-1062
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Fax |
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Provider Business Mailing Address
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Address Line | 417 ADMIRAL SEMMES AVE
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City | DAUPHIN ISLAND
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State | AL
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Zip | 36528-4551
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Country | US
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Telephone | 479-981-1065
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY L JEPPSEN
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Credential | PHD, LPC, LMFT
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Telephone | 479-981-1062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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