Provider Demographics
NPI:1700200102
Name:BUFFALO, JENNIFER WILLIAMS (MA, LPC, LMFTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WILLIAMS
Last Name:BUFFALO
Suffix:
Gender:F
Credentials:MA, LPC, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 E HWY 290 STE 110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1157
Mailing Address - Country:US
Mailing Address - Phone:512-657-7744
Mailing Address - Fax:
Practice Address - Street 1:6633 E HWY 290 STE 110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1157
Practice Address - Country:US
Practice Address - Phone:512-657-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202020106H00000X
TX68244101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist