Provider Demographics
NPI:1104130202
Name:BERRY, JEREMY J (LPC)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:J
Last Name:BERRY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 ZEPHYR ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-6727
Mailing Address - Country:US
Mailing Address - Phone:806-281-8400
Mailing Address - Fax:
Practice Address - Street 1:907 ZEPHYR ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-6727
Practice Address - Country:US
Practice Address - Phone:806-281-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64038101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional