Provider Demographics
NPI:1790467702
Name:JETTER & ASSOCIATES COUNSELING
Entity Type:Organization
Organization Name:JETTER & ASSOCIATES COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JETTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:215-645-0338
Mailing Address - Street 1:325 STREET RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3109
Mailing Address - Country:US
Mailing Address - Phone:215-645-0338
Mailing Address - Fax:215-709-3453
Practice Address - Street 1:325 STREET RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3109
Practice Address - Country:US
Practice Address - Phone:215-645-0338
Practice Address - Fax:215-709-3453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty