Provider Demographics
NPI:1356808224
Name:JENNA MUDD, LLC
Entity type:Organization
Organization Name:JENNA MUDD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-341-6008
Mailing Address - Street 1:219 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-1806
Mailing Address - Country:US
Mailing Address - Phone:662-341-6008
Mailing Address - Fax:256-999-0729
Practice Address - Street 1:219 S MARKET ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-1806
Practice Address - Country:US
Practice Address - Phone:256-999-0727
Practice Address - Fax:256-999-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)