Provider Demographics
NPI:1114397338
Name:BERENT, JENNIFER (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BERENT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CIRCLE DR
Mailing Address - Street 2:SUITE 2307
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-8134
Mailing Address - Country:US
Mailing Address - Phone:817-313-1385
Mailing Address - Fax:
Practice Address - Street 1:2300 CIRCLE DR
Practice Address - Street 2:SUITE 2307
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-8134
Practice Address - Country:US
Practice Address - Phone:817-313-1385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68796101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional