Provider Demographics
NPI:1760685028
Name:AUTRY, JENNIFER (BA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:AUTRY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-2096
Mailing Address - Country:US
Mailing Address - Phone:731-967-8803
Mailing Address - Fax:731-967-8784
Practice Address - Street 1:335 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-2096
Practice Address - Country:US
Practice Address - Phone:731-967-8803
Practice Address - Fax:731-967-8784
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor