Provider Demographics
NPI:1215443965
Name:JENNIFER J. KROCK PLLC
Entity type:Organization
Organization Name:JENNIFER J. KROCK PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JANINE
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC NCC
Authorized Official - Phone:210-920-5364
Mailing Address - Street 1:1580 S MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-3311
Mailing Address - Country:US
Mailing Address - Phone:210-920-5364
Mailing Address - Fax:830-331-8747
Practice Address - Street 1:1580 S MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3311
Practice Address - Country:US
Practice Address - Phone:210-920-5364
Practice Address - Fax:830-331-8747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71194101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty