Provider Demographics
NPI:1306508411
Name:QUINE, JENNIFER A (LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:A
Last Name:QUINE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:FELTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2902 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-3449
Mailing Address - Country:US
Mailing Address - Phone:903-746-7228
Mailing Address - Fax:
Practice Address - Street 1:1514 W FAIRMONT ST STE 102
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-4526
Practice Address - Country:US
Practice Address - Phone:903-746-7228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68055101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor