Provider Demographics
NPI:1609553908
Name:TARVES, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TARVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S WOODROW LN STE 500
Mailing Address - Street 2:PMB 1034
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-6328
Mailing Address - Country:US
Mailing Address - Phone:469-337-7768
Mailing Address - Fax:
Practice Address - Street 1:109 S WOODROW LN STE 500 PMB 1034
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-6328
Practice Address - Country:US
Practice Address - Phone:469-337-7768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83118101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional