Provider Demographics
NPI:1245432061
Name:DAVIS, JENNIFER LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:DAVIS
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 1:1217 RHODE ISLAND ST APT B
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-3388
Mailing Address - Country:US
Mailing Address - Phone:785-842-4965
Mailing Address - Fax:785-838-3091
Practice Address - Street 1:1217 RHODE ISLAND ST APT B
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-3388
Practice Address - Country:US
Practice Address - Phone:785-842-4965
Practice Address - Fax:785-838-3091
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS997101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health