Provider Demographics
NPI:1952975096
Name:MAAG, JENNIFER MELYNNE MCAFEE (PHD, LCPC, LPC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MELYNNE MCAFEE
Last Name:MAAG
Suffix:
Gender:F
Credentials:PHD, LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 W LORENA AVE
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:62095-1929
Mailing Address - Country:US
Mailing Address - Phone:618-973-1863
Mailing Address - Fax:
Practice Address - Street 1:22 W LORENA AVE
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-1929
Practice Address - Country:US
Practice Address - Phone:618-973-1863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008006386101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health