Provider Demographics
NPI:1942509740
Name:LAURICH, JENNIFER (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LAURICH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20541
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79114-2541
Mailing Address - Country:US
Mailing Address - Phone:806-676-6876
Mailing Address - Fax:806-223-0227
Practice Address - Street 1:6910 SW 45TH AVE STE 19
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5078
Practice Address - Country:US
Practice Address - Phone:806-676-6876
Practice Address - Fax:806-223-0227
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2191165-01Medicaid