Provider Demographics
NPI:1518682194
Name:KLINGENBERG, JENNIFER DAW (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAW
Last Name:KLINGENBERG
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 1:207 BLOUNT ST STE A
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-3541
Mailing Address - Country:US
Mailing Address - Phone:903-353-0940
Mailing Address - Fax:
Practice Address - Street 1:207 BLOUNT ST STE A
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-3541
Practice Address - Country:US
Practice Address - Phone:936-234-0578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15489101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor