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General NPI Number Information
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NPI Number | 1982208633
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Entity Type | Individual
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Provider Name | JENNIFER CAUDLE
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Gender | Female
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 303 W PEARL ST
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City | GRANBURY
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State | TX
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Zip | 76048-2451
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Country | US
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Telephone | 817-578-0189
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Fax |
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Provider Business Mailing Address
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Address Line | 900 DART CT
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City | GRANBURY
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State | TX
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Zip | 76049-1283
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Country | US
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Telephone | 817-578-0189
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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 | 80654
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License Number State | TX
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