Provider Demographics
NPI:1114537883
Name:POPE, JERILYN (LPC)
Entity Type:Individual
Prefix:
First Name:JERILYN
Middle Name:
Last Name:POPE
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:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:IDAHO CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83631-0454
Mailing Address - Country:US
Mailing Address - Phone:682-465-2648
Mailing Address - Fax:
Practice Address - Street 1:7006 KILDARE CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78724-3654
Practice Address - Country:US
Practice Address - Phone:682-465-2648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2023-08-22
Deactivation Date:2021-02-25
Deactivation Code:
Reactivation Date:2023-06-23
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
TX19297101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty