Provider Demographics
NPI:1225386089
Name:EMERY, JEFFREY DAVID
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DAVID
Last Name:EMERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CHESTNUT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-1440
Mailing Address - Country:US
Mailing Address - Phone:325-676-8963
Mailing Address - Fax:325-676-2915
Practice Address - Street 1:100 CHESTNUT ST STE 101
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-1440
Practice Address - Country:US
Practice Address - Phone:325-676-8963
Practice Address - Fax:325-676-2915
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201460106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist