Provider Demographics
NPI:1962781682
Name:JERI KOUNCE, LPC, LLC
Entity type:Organization
Organization Name:JERI KOUNCE, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:KOUNCE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:432-553-4697
Mailing Address - Street 1:1030 ANDREWS HWY
Mailing Address - Street 2:SUITE 203-B
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3872
Mailing Address - Country:US
Mailing Address - Phone:432-553-4697
Mailing Address - Fax:432-694-2525
Practice Address - Street 1:1030 ANDREWS HWY
Practice Address - Street 2:SUITE 203-B
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3872
Practice Address - Country:US
Practice Address - Phone:432-553-4697
Practice Address - Fax:432-694-2525
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JERI KOUNCE, LPC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61623251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1986069 02Medicaid
1467626358OtherNPI 1
1216317OtherCAQH