Provider Demographics
NPI:1346518297
Name:KINNEY, JONATHAN (LPC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:KINNEY
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:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-0459
Mailing Address - Country:US
Mailing Address - Phone:573-756-5749
Mailing Address - Fax:573-431-1673
Practice Address - Street 1:203 N GRAND ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-1344
Practice Address - Country:US
Practice Address - Phone:573-729-4103
Practice Address - Fax:573-729-4420
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016040024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional