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General NPI Number Information
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NPI Number | 1932793700
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Entity Type | Individual
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Provider Name | JENNIFER LEE MFT, MDIV, LMFT
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Gender | Female
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Dates
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Enumeration Date | 02/23/2021
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 2409 TOWN LAKE CIR APT 126
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City | AUSTIN
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State | TX
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Zip | 78741-3065
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Country | US
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Telephone | 856-600-1004
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Fax |
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Provider Business Mailing Address
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Address Line | 13026 TAMAYO DR
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City | AUSTIN
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State | TX
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Zip | 78729-7380
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Country | US
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Telephone | 210-560-1983
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 202451
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 723
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License Number State | NH
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