Provider Demographics
NPI:1871299859
Name:DOHERTY, JENNIFER (MED, LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DOHERTY
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 1:138 HIGH RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-1775
Mailing Address - Country:US
Mailing Address - Phone:940-290-0010
Mailing Address - Fax:
Practice Address - Street 1:2214 EMERY ST STE 510
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2476
Practice Address - Country:US
Practice Address - Phone:940-239-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90553101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional