Provider Demographics
NPI:1659847077
Name:IACCO, JENA M (LPCC-S)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:M
Last Name:IACCO
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8404 N BOYDEN RD
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44067-1718
Mailing Address - Country:US
Mailing Address - Phone:216-816-7439
Mailing Address - Fax:
Practice Address - Street 1:6500 ROCKSIDE RD STE 385
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2353
Practice Address - Country:US
Practice Address - Phone:216-468-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1801539101YP2500X
E.2102128101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1659847077Medicaid
OHAPP-00172576OtherLICENSE/ ENDORSEMENT NUMBER - COUNSELOR