Provider Demographics
NPI:1649584707
Name:COKE, JENNIFER H (MED)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:H
Last Name:COKE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 AUSTIN AVE STE 803
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-1946
Mailing Address - Country:US
Mailing Address - Phone:254-715-2514
Mailing Address - Fax:
Practice Address - Street 1:900 AUSTIN AVE STE 803
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1946
Practice Address - Country:US
Practice Address - Phone:254-715-2514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-01
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64149101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional