Provider Demographics
NPI:1801298344
Name:POPOVICH, JENNIFER DENITRA (LPC, NCC, CDWF, MAC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DENITRA
Last Name:POPOVICH
Suffix:
Gender:F
Credentials:LPC, NCC, CDWF, MAC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC, CDWF, MAC
Mailing Address - Street 1:1205 N HIGHWAY 123
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7756
Mailing Address - Country:US
Mailing Address - Phone:512-230-9103
Mailing Address - Fax:512-858-9620
Practice Address - Street 1:1205 N HIGHWAY 123
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7756
Practice Address - Country:US
Practice Address - Phone:512-230-9103
Practice Address - Fax:512-858-9620
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69812101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor