Provider Demographics
NPI:1598009987
Name:GAULT, JENIFER LEIGH (LMFT)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:LEIGH
Last Name:GAULT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JNEIFER
Other - Middle Name:LEIGH
Other - Last Name:GAULT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:222 BIRD MOUNTAIN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LANDRUM
Mailing Address - State:SC
Mailing Address - Zip Code:29356-9677
Mailing Address - Country:US
Mailing Address - Phone:864-435-7095
Mailing Address - Fax:
Practice Address - Street 1:222 BIRD MOUNTAIN RIDGE RD
Practice Address - Street 2:
Practice Address - City:LANDRUM
Practice Address - State:SC
Practice Address - Zip Code:29356-9677
Practice Address - Country:US
Practice Address - Phone:864-435-7095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4616106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist