Provider Demographics
NPI:1245759323
Name:EWING, JENNIFER (MED, LPCA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:EWING
Suffix:
Gender:F
Credentials:MED, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 ALVEY PARK DR W STE 400
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2191
Mailing Address - Country:US
Mailing Address - Phone:606-393-6695
Mailing Address - Fax:606-886-4433
Practice Address - Street 1:3032 ALVEY PARK DR W
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2191
Practice Address - Country:US
Practice Address - Phone:606-393-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health