Provider Demographics
NPI:1457642431
Name:SPEARS, JENNIFER (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SPEARS
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 1:14114 N DALLAS PWKY
Mailing Address - Street 2:STE 245
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254
Mailing Address - Country:US
Mailing Address - Phone:214-762-6054
Mailing Address - Fax:
Practice Address - Street 1:14114 N DALLAS PWKY
Practice Address - Street 2:STE 245
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254
Practice Address - Country:US
Practice Address - Phone:214-762-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64477101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional