Provider Demographics
NPI:1558514539
Name:JEPSEN, MARY ANN B (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:B
Last Name:JEPSEN
Suffix:
Gender:F
Credentials:LPCC
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Mailing Address - Street 1:PO BOX 1586
Mailing Address - Street 2:COVENANT INTEGRATIVE COUNSELING SERVICES
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-1586
Mailing Address - Country:US
Mailing Address - Phone:614-309-2270
Mailing Address - Fax:614-436-6884
Practice Address - Street 1:9633 E STATE ROUTE 37
Practice Address - Street 2:ST. JOHN NEUMANN CATHOLIC CATHOLIC CHURCH
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-9672
Practice Address - Country:US
Practice Address - Phone:614-309-2270
Practice Address - Fax:614-436-6884
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHE 0700010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12218499OtherCAQH