Provider Demographics
NPI:1669170502
Name:MOORE, JENNIFER WILLS (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:WILLS
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 COUNTY ROAD 396
Mailing Address - Street 2:
Mailing Address - City:JARRELL
Mailing Address - State:TX
Mailing Address - Zip Code:76537-1113
Mailing Address - Country:US
Mailing Address - Phone:512-240-2526
Mailing Address - Fax:
Practice Address - Street 1:325 COUNTY ROAD 396
Practice Address - Street 2:
Practice Address - City:JARRELL
Practice Address - State:TX
Practice Address - Zip Code:76537-1113
Practice Address - Country:US
Practice Address - Phone:512-240-2526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78581101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor