Provider Demographics
NPI:1366763443
Name:KERN, JENNIFER (MS, LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KERN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WOODLAND RD APT 713
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-3319
Mailing Address - Country:US
Mailing Address - Phone:903-824-2050
Mailing Address - Fax:
Practice Address - Street 1:5221 N PARK RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2664
Practice Address - Country:US
Practice Address - Phone:903-824-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-12
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64416101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional