Provider Demographics
NPI:1023881885
Name:CHEATHAM, JENNIFER ANN (LPC-A)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 ANGELFIRE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7611
Mailing Address - Country:US
Mailing Address - Phone:512-426-5775
Mailing Address - Fax:
Practice Address - Street 1:1314 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78733-6501
Practice Address - Country:US
Practice Address - Phone:512-426-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91650101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional