Provider Demographics
NPI:1548695364
Name:STEVENSON, JENNIFER L (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 HEDGCOXE RD
Mailing Address - Street 2:#250945
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0818
Mailing Address - Country:US
Mailing Address - Phone:773-807-3520
Mailing Address - Fax:214-593-5516
Practice Address - Street 1:3905 HEDGCOXE RD
Practice Address - Street 2:#250945
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-0818
Practice Address - Country:US
Practice Address - Phone:773-807-3520
Practice Address - Fax:214-593-5516
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008341101YP2500X
TX72498101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional