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NPI Code Detail

MEDICARE: JENNIFER MARLENE HALLCROFT LPC

MEDICARE: JENNIFER MARLENE HALLCROFT 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
1101YP2500XProfessional Counselor63913TX

General Provider Information

NPI Number : 1255640397
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MARLENE HALLCROFT LPC
Provider Business Mailing Address
First Line : 4686 BRISTOL TRACE TRL
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-6947
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4686 BRISTOL TRACE TRL
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-6947
Country : US
Telephone Number : 817-880-3640
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2010
Last Update Date : 09/13/2019

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