Provider Demographics
NPI:1699529008
Name:BLUNT, JENNIFER (ALC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BLUNT
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:EAST BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-2520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 FORREST AVE
Practice Address - Street 2:
Practice Address - City:EAST BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-2520
Practice Address - Country:US
Practice Address - Phone:251-286-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL04291101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional