Provider Demographics
NPI:1851845598
Name:HERNDON, JENNIFER PARKS (MS LPC-CR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PARKS
Last Name:HERNDON
Suffix:
Gender:F
Credentials:MS LPC-CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1791 ALUM CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1708
Mailing Address - Country:US
Mailing Address - Phone:614-445-8131
Mailing Address - Fax:614-827-8380
Practice Address - Street 1:1430 SOUTH HIGH STREET
Practice Address - Street 2:SUITE 112
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207
Practice Address - Country:US
Practice Address - Phone:614-357-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C1300069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional