Provider Demographics
NPI:1588493936
Name:OCCHIPINTI, JENNIFER DALE (LCSW, LCDC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DALE
Last Name:OCCHIPINTI
Suffix:
Gender:
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1030 E HWY 377 STE 110
Mailing Address - Street 2:PMB 412
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-1244
Mailing Address - Country:US
Mailing Address - Phone:817-330-4898
Mailing Address - Fax:844-999-1487
Practice Address - Street 1:1201 W 2ND ST STE 105
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1490
Practice Address - Country:US
Practice Address - Phone:817-330-4898
Practice Address - Fax:844-999-1487
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15960101YA0400X
TX69404104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker