Provider Demographics
NPI:1962243683
Name:MINCKLER, JENNIFER (LMFT, LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MINCKLER
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9189
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77842-9189
Mailing Address - Country:US
Mailing Address - Phone:979-216-5956
Mailing Address - Fax:
Practice Address - Street 1:3833 S TEXAS AVE STE 285
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4042
Practice Address - Country:US
Practice Address - Phone:979-216-5956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203735106H00000X
TX87078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional