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General NPI Number Information
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NPI Number | 1467809053
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Entity Type | Individual
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Provider Name | JENNIFER LYNN SHIRLEY LMHC, LPC, CRC
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Gender | Female
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 569 MAIN ST
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City | WARREN
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State | RI
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Zip | 02885-4356
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Country | US
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Telephone | 401-903-0324
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Fax |
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Provider Business Mailing Address
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Address Line | 20 HEARTHSTONE DR
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City | HEBRON
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State | CT
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Zip | 06248-1202
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Country | US
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Telephone | 401-903-0324
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 006960
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 00233417
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MHC01054
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License Number State | RI
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