MEDICARE: MS. JENNIFER RENAE AVERY-WILLIAMS 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	6401014792	MI

General Provider Information

NPI Number	:	1881073724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER RENAE AVERY-WILLIAMS LPC

Provider Business Mailing Address
First Line	:	3236 FORUM BLVD
Second Line	:	#1109
City	:	FORT MYERS
State	:	FL
Zip	:	33905
Country	:	US
Telephone Number	:	239-373-7999
Fax Number	:

Provider Business Practice Location Address
First Line	:	2337 N PARK DR # 1001
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-8522
Country	:	US
Telephone Number	:	239-373-7999
Fax Number	:

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

Provider Enumeration Date	:	05/26/2015
Last Update Date	:	01/13/2025

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