MEDICARE: JENNI DORIS JENNINGS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	10663	TX

General Provider Information

NPI Number	:	1073839387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNI DORIS JENNINGS LPC

Provider Business Mailing Address
First Line	:	1013 N MADISON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-4131
Country	:	US
Telephone Number	:	214-942-2699
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 GREENVILLE AVE STE 252
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-5037
Country	:	US
Telephone Number	:	844-824-8775
Fax Number	:	281-648-2200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2010
Last Update Date	:	04/05/2023

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