Provider Demographics
NPI:1306216833
Name:CHISHOLM, JENNY (LPC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:CHISHOLM
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 1:9535 FOREST LN
Mailing Address - Street 2:SUITE 212
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5900
Mailing Address - Country:US
Mailing Address - Phone:972-824-0668
Mailing Address - Fax:
Practice Address - Street 1:9535 FOREST LN
Practice Address - Street 2:SUITE 212
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5900
Practice Address - Country:US
Practice Address - Phone:972-824-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-26
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68134101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional