Provider Demographics
NPI:1437444700
Name:PERRY, JENNIFER ERIN (MA, LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ERIN
Last Name:PERRY
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 NASH AVE
Mailing Address - Street 2:#103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8991
Mailing Address - Country:US
Mailing Address - Phone:512-947-9370
Mailing Address - Fax:
Practice Address - Street 1:6448 E HWY 290
Practice Address - Street 2:BLDG. E-114
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1068
Practice Address - Country:US
Practice Address - Phone:512-947-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63487101YP2500X
TX201329106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist