Provider Demographics
NPI:1306414966
Name:OUSLEY, JENNIFER JAMES (LIC PSYCH ASSOC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JAMES
Last Name:OUSLEY
Suffix:
Gender:F
Credentials:LIC PSYCH ASSOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8271 STATE ROAD FRK
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-2218
Mailing Address - Country:US
Mailing Address - Phone:606-226-6467
Mailing Address - Fax:
Practice Address - Street 1:3056 KY ROUTE 321
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9105
Practice Address - Country:US
Practice Address - Phone:606-887-9221
Practice Address - Fax:833-550-0816
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY139034103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty