Provider Demographics
NPI:1831637313
Name:PACE, JENITA LEE (LPC)
Entity Type:Individual
Prefix:
First Name:JENITA
Middle Name:LEE
Last Name:PACE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 METRO PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1509
Mailing Address - Country:US
Mailing Address - Phone:612-361-9325
Mailing Address - Fax:
Practice Address - Street 1:7800 METRO PKWY STE 300
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1509
Practice Address - Country:US
Practice Address - Phone:612-361-9325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01928101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health