Provider Demographics
NPI:1023029030
Name:GUILLETTE, JENNIFER KELLY (MA, NCC, LPC-S)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:KELLY
Last Name:GUILLETTE
Suffix:
Gender:F
Credentials:MA, NCC, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1087
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:903-253-1633
Mailing Address - Fax:469-777-3910
Practice Address - Street 1:8641 5TH ST # W4
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4290
Practice Address - Country:US
Practice Address - Phone:903-253-1633
Practice Address - Fax:469-777-3910
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18373101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1608291-03Medicaid
TX160829103Medicaid