Provider Demographics
NPI:1689338634
Name:HUBBARD, JENNIFER (LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5457 RICHARD AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-6713
Mailing Address - Country:US
Mailing Address - Phone:803-479-5096
Mailing Address - Fax:
Practice Address - Street 1:4849 GREENVILLE AVE STE 1675
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4153
Practice Address - Country:US
Practice Address - Phone:214-886-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84844101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health