Individual
JENNIFER PENICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
460 BRIARWOOD DRIVE, SUITE 510, JACKSON, MS 39206
(601) 454-0521
(601) 956-4817
Mailing address
460 BRIARWOOD DR STE 510, JACKSON, MS 39206
(601) 956-4816
(601) 956-4817
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01670076
—
MS
Enumeration date
11/18/2016
Last updated
11/18/2016
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