Provider Demographics
NPI:1376944918
Name:CAIN, JEANNIE MARIE (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:MARIE
Last Name:CAIN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MRS
Other - First Name:JEANNIE
Other - Middle Name:MARIE
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LPCC, NBCC
Mailing Address - Street 1:17 US HIGHWAY 68 W
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-7002
Mailing Address - Country:US
Mailing Address - Phone:270-349-1722
Mailing Address - Fax:270-215-1224
Practice Address - Street 1:17 US HIGHWAY 68 W
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025
Practice Address - Country:US
Practice Address - Phone:270-349-1722
Practice Address - Fax:270-215-1224
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1804101YP2500X
KY165329101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100407109Medicaid