Provider Demographics
NPI:1467626358
Name:KOUNCE, JERI JO (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JERI
Middle Name:JO
Last Name:KOUNCE
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 1:4500 W ILLINOIS AVE
Mailing Address - Street 2:SUITE 119A, BOX 5
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5491
Mailing Address - Country:US
Mailing Address - Phone:432-553-4697
Mailing Address - Fax:432-694-2525
Practice Address - Street 1:4500 W ILLINOIS AVE
Practice Address - Street 2:SUITE 119A, BOX 5
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5491
Practice Address - Country:US
Practice Address - Phone:432-553-4697
Practice Address - Fax:432-694-2525
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61623101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198606902Medicaid