Provider Demographics
NPI:1104201516
Name:LOYD, JENNIFER R (MS)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:R
Last Name:LOYD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E HAWTHORN PKWY
Mailing Address - Street 2:SUITE 235
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061
Mailing Address - Country:US
Mailing Address - Phone:817-751-7802
Mailing Address - Fax:847-959-5885
Practice Address - Street 1:6100 WESTERN PL
Practice Address - Street 2:SUITE 908
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107
Practice Address - Country:US
Practice Address - Phone:817-751-7802
Practice Address - Fax:847-859-5885
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 11823101YM0800X
TX76281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
339765OtherNCC