Provider Demographics
NPI:1821134859
Name:JEFFERS, CAROL J (LPC MASTERS DEGREE)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:J
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:LPC MASTERS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 SOUTH MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901
Mailing Address - Country:US
Mailing Address - Phone:325-653-8635
Mailing Address - Fax:
Practice Address - Street 1:2013 WEST BEAUREGARD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901
Practice Address - Country:US
Practice Address - Phone:325-653-8635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3399101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional