Provider Demographics
NPI:1659731834
Name:MUDD, JENNA LEANN (LPC)
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:LEANN
Last Name:MUDD
Suffix:
Gender:
Credentials:LPC
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:LEANN
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:142 HOLLY FERN DR
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-2301
Mailing Address - Country:US
Mailing Address - Phone:662-341-6008
Mailing Address - Fax:662-341-6008
Practice Address - Street 1:142 HOLLY FERN DR
Practice Address - Street 2:
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749-2301
Practice Address - Country:US
Practice Address - Phone:662-341-6008
Practice Address - Fax:662-341-6008
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3946101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health