Provider Demographics
NPI:1124354469
Name:URBAN, JENNIFER BROOKE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BROOKE
Last Name:URBAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1521
Mailing Address - Street 2:
Mailing Address - City:CARRIZO SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78834-7521
Mailing Address - Country:US
Mailing Address - Phone:830-255-0455
Mailing Address - Fax:830-876-0061
Practice Address - Street 1:1022 GARNER FIELD RD
Practice Address - Street 2:SUITE C
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-4867
Practice Address - Country:US
Practice Address - Phone:830-486-0960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX414161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical