Provider Demographics
NPI:1124684352
Name:MCGILL, JENNIFER (LPC-S)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MCGILL
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19141 STONE OAK PKWY # 104-100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3366
Mailing Address - Country:US
Mailing Address - Phone:210-317-3229
Mailing Address - Fax:
Practice Address - Street 1:19141 STONE OAK PKWY # 104-100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3366
Practice Address - Country:US
Practice Address - Phone:210-317-3229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional