Provider Demographics
NPI:1306314661
Name:MEADOR, JENNIFER WENTZ (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WENTZ
Last Name:MEADOR
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-7804
Mailing Address - Country:US
Mailing Address - Phone:678-641-1477
Mailing Address - Fax:
Practice Address - Street 1:1708 COUNTY ROAD 32
Practice Address - Street 2:
Practice Address - City:JACHIN
Practice Address - State:AL
Practice Address - Zip Code:36910-3210
Practice Address - Country:US
Practice Address - Phone:678-641-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
657081101Y00000X
MS2420101YP2500X
AL3973101YP2500X
PAPC013684101YP2500X
COLPC.0017271101YP2500X
FLTPMC1060101YP2500X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional