Provider Demographics
NPI:1417630070
Name:JEAN, DANNA (RMHCI)
Entity Type:Individual
Prefix:
First Name:DANNA
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7930 BRENTLINGER PARK PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-8349
Mailing Address - Country:US
Mailing Address - Phone:803-237-1459
Mailing Address - Fax:
Practice Address - Street 1:7930 BRENTLINGER PARK PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-8349
Practice Address - Country:US
Practice Address - Phone:803-237-1459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24466101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health