Provider Demographics
NPI:1780115196
Name:GAMEWELL, JENNIFER (MED, LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GAMEWELL
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 MERION DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-4730
Mailing Address - Country:US
Mailing Address - Phone:512-484-1976
Mailing Address - Fax:
Practice Address - Street 1:8101 W HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8103
Practice Address - Country:US
Practice Address - Phone:512-484-1976
Practice Address - Fax:512-484-1976
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73964101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional