Provider Demographics
NPI:1932594322
Name:MAYER, JENNIE C (MS, NCC, LPC, LAC)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:C
Last Name:MAYER
Suffix:
Gender:F
Credentials:MS, NCC, LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 S WESTERN AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3412
Mailing Address - Country:US
Mailing Address - Phone:605-310-0032
Mailing Address - Fax:
Practice Address - Street 1:6330 S WESTERN AVE STE 140
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-3412
Practice Address - Country:US
Practice Address - Phone:605-310-0032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD15031688101YA0400X
SDLPC7237101YM0800X
SDLPC-MH2319101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)