Provider Demographics
NPI:1164984266
Name:WASHBURN, JENNIFER (LPC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 PARKMONT DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-5684
Mailing Address - Country:US
Mailing Address - Phone:817-714-1387
Mailing Address - Fax:
Practice Address - Street 1:2080 N HWY 360 STE 430
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1430
Practice Address - Country:US
Practice Address - Phone:817-714-1387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201958106H00000X
TX70267101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist