Provider Demographics
NPI:1083879977
Name:COURREGES, JENNIFER JANEL (MS, LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JANEL
Last Name:COURREGES
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18612 WHEELOCK CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-4157
Mailing Address - Country:US
Mailing Address - Phone:512-484-7111
Mailing Address - Fax:
Practice Address - Street 1:12600 HILL COUNTRY BLVD STE R-275
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-6768
Practice Address - Country:US
Practice Address - Phone:512-484-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004358101YP2500X
TX80130101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional