Provider Demographics
NPI:1194317453
Name:JEPPSEN ENTERPRISES
Entity type:Organization
Organization Name:JEPPSEN ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JEPPSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, LMFT
Authorized Official - Phone:479-981-1062
Mailing Address - Street 1:417 ADMIRAL SEMMES AVE
Mailing Address - Street 2:
Mailing Address - City:DAUPHIN ISLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36528-4551
Mailing Address - Country:US
Mailing Address - Phone:479-981-1065
Mailing Address - Fax:
Practice Address - Street 1:4321 BOULEVARD PARK S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3404
Practice Address - Country:US
Practice Address - Phone:479-981-1062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty