Provider Demographics
NPI:1467841031
Name:SEITZ, JESSICA ROSE (LPCC, LICDC)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ROSE
Last Name:SEITZ
Suffix:
Gender:F
Credentials:LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 MEDINA RD
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5360
Mailing Address - Country:US
Mailing Address - Phone:330-722-2916
Mailing Address - Fax:330-722-3204
Practice Address - Street 1:3443 MEDINA RD
Practice Address - Street 2:SUITE 101B
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5360
Practice Address - Country:US
Practice Address - Phone:330-722-2916
Practice Address - Fax:330-722-3204
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141097101YA0400X
OHE1000041101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)