Provider Demographics
NPI:1316403546
Name:PEEVEY, JENNIFER ANN (MED, LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:PEEVEY
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6104 US HIGHWAY 83
Mailing Address - Street 2:
Mailing Address - City:SHAMROCK
Mailing Address - State:TX
Mailing Address - Zip Code:79079-6924
Mailing Address - Country:US
Mailing Address - Phone:806-216-1021
Mailing Address - Fax:
Practice Address - Street 1:6104 US HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:SHAMROCK
Practice Address - State:TX
Practice Address - Zip Code:79079-6924
Practice Address - Country:US
Practice Address - Phone:806-216-1021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77789101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional