Individual
MRS. JENNA A MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED, LPC
Contact information
Practice address
1207 S WHITE CHAPEL BLVD STE 105, SOUTHLAKE, TX 76092-9315
(214) 810-3756
Mailing address
1207 S WHITE CHAPEL BLVD STE 105, SOUTHLAKE, TX 76092-9315
(214) 810-3756
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
66288
TX
Other
Enumeration date
09/27/2012
Last updated
10/15/2015
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