MEDICARE: JENNIFER DONN HENRY 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	101YM0800X	Mental Health Counselor	2020027805	MO

General Provider Information

NPI Number	:	1104430610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DONN HENRY LPC

Provider Business Mailing Address
First Line	:	PO BOX 100
Second Line	:
City	:	PIERCE CITY
State	:	MO
Zip	:	65723-2100
Country	:	US
Telephone Number	:	417-476-1013
Fax Number	:	417-476-1082

Provider Business Practice Location Address
First Line	:	1701 N CENTRAL AVE
Second Line	:
City	:	MONETT
State	:	MO
Zip	:	65708-1144
Country	:	US
Telephone Number	:	417-476-1000
Fax Number	:

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

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	08/12/2024

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