| Jennifer Staten, Lcsw, Llc | |
|
2121 Main St Sulphur Springs TX 75482-3616 | |
| (903) 885-2776 | |
| Not Available |
| Full Name | Jennifer Staten, Lcsw, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2121 Main St, Sulphur Springs, Texas |
| Authorized Official Name and Position | Jennifer N Staten (OWNER/OPERATOR) |
| Authorized Official Contact | 9035776263 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jennifer Staten, Lcsw, Llc Po Box 146 Sulphur Springs TX 75483-0146 Ph: (903) 885-2776 | Jennifer Staten, Lcsw, Llc 2121 Main St Sulphur Springs TX 75482-3616 Ph: (903) 885-2776 |
| NPI Number | 1629669981 |
|---|---|
| Provider Enumeration Date | 01/29/2021 |
| Last Update Date | 03/11/2023 |
| Medicare PECOS PAC ID | 6901212273 |
|---|---|
| Medicare Enrollment ID | O20210311000204 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629669981 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Jennifer N Staten |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811507189 PECOS PAC ID: 7810312758 Enrollment ID: I20200810000580 |
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