Provider Demographics
NPI:1205481207
Name:WILLIAMSON, JENNIFER NIVIN (PHD, LPC, LPCC-S)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NIVIN
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:PHD, LPC, LPCC-S
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 2202
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-2202
Mailing Address - Country:US
Mailing Address - Phone:502-438-8711
Mailing Address - Fax:
Practice Address - Street 1:1205 THISTLE PARK
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-7292
Practice Address - Country:US
Practice Address - Phone:502-438-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY102990101YP2500X
TX76332101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional