MEDICARE: MRS. JENNIFER L CANUL 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	19426	TX

General Provider Information

NPI Number	:	1447556089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER L CANUL LPC

Provider Business Mailing Address
First Line	:	13100 WORTHAM CENTER DR
Second Line	:	SUITE 240
City	:	HOUSTON
State	:	TX
Zip	:	77065-5625
Country	:	US
Telephone Number	:	832-688-9747
Fax Number	:	832-688-8415

Provider Business Practice Location Address
First Line	:	13100 WORTHAM CENTER DR
Second Line	:	SUITE 240
City	:	HOUSTON
State	:	TX
Zip	:	77065-5625
Country	:	US
Telephone Number	:	832-688-9747
Fax Number	:	832-688-8415

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

Provider Enumeration Date	:	01/30/2011
Last Update Date	:	01/30/2011

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