Provider Demographics
NPI:1316132186
Name:SIGREST, JENNIFER L (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SIGREST
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39060-0361
Mailing Address - Country:US
Mailing Address - Phone:601-427-5158
Mailing Address - Fax:601-429-1615
Practice Address - Street 1:103 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4309
Practice Address - Country:US
Practice Address - Phone:601-427-5158
Practice Address - Fax:601-429-1615
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSLPC 0552101Y00000X
MS0552101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04558375Medicaid