Provider Demographics
NPI:1578114153
Name:COLON, JENNIFER LW (LPC, ATR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LW
Last Name:COLON
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 W LOVERS LN APT 111
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-3168
Mailing Address - Country:US
Mailing Address - Phone:197-236-5953
Mailing Address - Fax:
Practice Address - Street 1:4616 W LOVERS LN APT 111
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-3168
Practice Address - Country:US
Practice Address - Phone:469-572-2932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX770931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health