Provider Demographics
NPI:1346547338
Name:EWING, JENNIFER J (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:EWING
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 SPRINGBROOK ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2162
Mailing Address - Country:US
Mailing Address - Phone:936-556-0552
Mailing Address - Fax:
Practice Address - Street 1:1812 SPRINGBROOK ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2162
Practice Address - Country:US
Practice Address - Phone:936-556-0552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62615101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional