MEDICARE: JENNIFER LAUREN ACKERMAN MS, LMFT-A, LPC-I

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	202764	TX

General Provider Information

NPI Number	:	1780175265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LAUREN ACKERMAN MS, LMFT-A, LPC-I

Provider Business Mailing Address
First Line	:	821 MARLIN ST
Second Line	:
City	:	BAYOU VISTA
State	:	TX
Zip	:	77563-2614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 E MAIN ST # 235
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3742
Country	:	US
Telephone Number	:	281-944-8218
Fax Number	:

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

Provider Enumeration Date	:	05/21/2018
Last Update Date	:	05/21/2018

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