Provider Demographics
NPI:1053782763
Name:VARNER, JENNIFER (BA, MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:VARNER
Suffix:
Gender:F
Credentials:BA, MA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:BAUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA, MA
Mailing Address - Street 1:3124 MARYE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-4932
Mailing Address - Country:US
Mailing Address - Phone:318-277-1765
Mailing Address - Fax:
Practice Address - Street 1:3600 JACKSON ST STE 119
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3096
Practice Address - Country:US
Practice Address - Phone:318-625-7050
Practice Address - Fax:318-625-7197
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
LA6116101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health