Provider Demographics
NPI:1043441926
Name:LAWLER, JENNIFER L (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:LAWLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 CLARK AVE STE G
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-1065
Mailing Address - Country:US
Mailing Address - Phone:363-888-4496
Mailing Address - Fax:
Practice Address - Street 1:500 CLARK AVE STE G
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1065
Practice Address - Country:US
Practice Address - Phone:636-388-8449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019047974101YP2500X
MO2005027317101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490081080Medicaid