Provider Demographics
NPI:1891093191
Name:PINK, JENNIFER CAROLINE (MS - LPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CAROLINE
Last Name:PINK
Suffix:
Gender:F
Credentials:MS - LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12421 HARDY ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1444
Mailing Address - Country:US
Mailing Address - Phone:913-244-2696
Mailing Address - Fax:
Practice Address - Street 1:201 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2507
Practice Address - Country:US
Practice Address - Phone:816-322-4332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009032550101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional