Provider Demographics
NPI:1477887941
Name:JENNIFER L DORRELL MS LPC INC
Entity Type:Organization
Organization Name:JENNIFER L DORRELL MS LPC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:DORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:409-838-5201
Mailing Address - Street 1:5825 PHELAN BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-6249
Mailing Address - Country:US
Mailing Address - Phone:409-838-5201
Mailing Address - Fax:409-860-5777
Practice Address - Street 1:5825 PHELAN BLVD
Practice Address - Street 2:STE 101
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6249
Practice Address - Country:US
Practice Address - Phone:409-838-5201
Practice Address - Fax:409-860-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16224101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0285728-01Medicaid