Provider Demographics
NPI:1659731834
Name:MUDD, JENNA LEANN (MS, CRC)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LEANN
Last Name:MUDD
Suffix:
Gender:F
Credentials:MS, CRC
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:LEANN
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:219 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-1806
Mailing Address - Country:US
Mailing Address - Phone:256-999-0727
Mailing Address - Fax:256-999-0729
Practice Address - Street 1:219 S MARKET ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-1806
Practice Address - Country:US
Practice Address - Phone:256-999-0727
Practice Address - Fax:256-999-0729
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health