Provider Demographics
NPI:1699060301
Name:WALKER, JENNIFER AMANDA (LPC)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:AMANDA
Last Name:WALKER
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 1:2893 BLUE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LYNNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38472-5017
Mailing Address - Country:US
Mailing Address - Phone:931-527-4062
Mailing Address - Fax:931-527-4062
Practice Address - Street 1:219 CUMMINS ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-2806
Practice Address - Country:US
Practice Address - Phone:615-790-1956
Practice Address - Fax:615-472-8817
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001771101Y00000X
CO1211101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor