Provider Demographics
NPI:1962208041
Name:DRIVER, JENNIFER LYN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:DRIVER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8174 HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-9517
Mailing Address - Country:US
Mailing Address - Phone:432-413-3076
Mailing Address - Fax:
Practice Address - Street 1:8174 HILLS PKWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-9517
Practice Address - Country:US
Practice Address - Phone:432-413-3076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional