Provider Demographics
NPI:1093722514
Name:DORRELL, JENNIFER L (MS LPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:DORRELL
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 1:5825 PHELAN BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-6249
Mailing Address - Country:US
Mailing Address - Phone:409-838-5201
Mailing Address - Fax:409-860-5777
Practice Address - Street 1:5825 PHELAN BLVD
Practice Address - Street 2:STE 101
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6249
Practice Address - Country:US
Practice Address - Phone:409-838-5201
Practice Address - Fax:409-860-5777
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16224101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0285728-01Medicaid
TX6093LCOtherBCBS