=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902349269
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JENNIFER MCADAMS, PH.D., PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2016
-----------------------------------------------------
Last Update Date | 11/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 827 WEST 12TH STREET #5
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-239-9771
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 SANCHEZ ST APT B
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78702-1639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-239-9771
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | JENNIFER MCADAMS
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 281-239-9771
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 37211
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------