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NPI Code Detail

MEDICARE: JENNIFER ANDERSON M.A., LPC-S

MEDICARE: JENNIFER ANDERSON M.A., LPC-S
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
1101YM0800XMental Health Counselor65173TX
2101YP2500XProfessional Counselor65173TX

General Provider Information

NPI Number : 1962853176
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ANDERSON M.A., LPC-S
Provider Business Mailing Address
First Line : 9801 WILD GINGER DR
Second Line :
City : MCKINNEY
State : TX
Zip : 75072-2868
Country : US
Telephone Number : 415-370-2687
Fax Number :
Provider Business Practice Location Address
First Line : 161 W 3RD ST STE 100
Second Line :
City : PROSPER
State : TX
Zip : 75078-2906
Country : US
Telephone Number : 214-618-8402
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2016
Last Update Date : 09/20/2019

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