Provider Demographics
NPI:1588912976
Name:DAVIS-MULLER, JENNIFER (NCC, LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DAVIS-MULLER
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 PLEASURE HILL RD
Mailing Address - Street 2:
Mailing Address - City:N FRANKLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06254-1008
Mailing Address - Country:US
Mailing Address - Phone:860-917-3228
Mailing Address - Fax:
Practice Address - Street 1:210 ROUTE 32 STE 103
Practice Address - Street 2:
Practice Address - City:NORTH FRANKLIN
Practice Address - State:CT
Practice Address - Zip Code:06254-1813
Practice Address - Country:US
Practice Address - Phone:860-917-3228
Practice Address - Fax:860-889-2985
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2019-11-27
Deactivation Date:2014-10-06
Deactivation Code:
Reactivation Date:2015-10-26
Provider Licenses
StateLicense IDTaxonomies
002201101YP2500X
CT002201101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional