Provider Demographics
NPI:1073878799
Name:HOLLAND, JESSICA ANN KYNION (LPCC-S)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN KYNION
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2248 GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2609
Mailing Address - Country:US
Mailing Address - Phone:740-438-1762
Mailing Address - Fax:
Practice Address - Street 1:312 3RD ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-5618
Practice Address - Country:US
Practice Address - Phone:440-323-5707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1100550-TRNE101YM0800X
OHE.1100550-S101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health