Provider Demographics
NPI:1487681888
Name:MUTH, JEANETTE H (LPC)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:H
Last Name:MUTH
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 1:2868 ACTON RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2502
Mailing Address - Country:US
Mailing Address - Phone:205-968-8360
Mailing Address - Fax:205-968-8373
Practice Address - Street 1:825 RICE MINE RD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2314
Practice Address - Country:US
Practice Address - Phone:205-391-3099
Practice Address - Fax:205-391-9793
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2053101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51506807OtherBCBS