Provider Demographics
NPI:1821351677
Name:SEYMOUR, JENNIFER MARIE (PHD, PCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:PHD, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 CHERRY ST.
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2801
Mailing Address - Country:US
Mailing Address - Phone:419-720-9247
Mailing Address - Fax:419-720-0304
Practice Address - Street 1:1822 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2801
Practice Address - Country:US
Practice Address - Phone:419-720-9247
Practice Address - Fax:419-720-0304
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0600257101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional