Provider Demographics
NPI:1073537825
Name:JENNESS, ROBERT L (LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:JENNESS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SHAWNEE TRL
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-1020
Mailing Address - Country:US
Mailing Address - Phone:724-942-9350
Mailing Address - Fax:724-942-9350
Practice Address - Street 1:1385 WASHINGTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9674
Practice Address - Country:US
Practice Address - Phone:724-222-2605
Practice Address - Fax:724-222-2509
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002564101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional