Provider Demographics
NPI:1821467283
Name:SOUTH, JENNIFER (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:SOUTH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S SPRING ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-1250
Mailing Address - Country:US
Mailing Address - Phone:814-424-3638
Mailing Address - Fax:
Practice Address - Street 1:111 SOUTH SPRING ST STE 9
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-1250
Practice Address - Country:US
Practice Address - Phone:814-424-3638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003624101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health