Provider Demographics
NPI:1912042334
Name:BEHM, JEANETTE D (LPCC)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:D
Last Name:BEHM
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-3125
Mailing Address - Country:US
Mailing Address - Phone:440-428-5707
Mailing Address - Fax:440-428-3010
Practice Address - Street 1:15 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-3125
Practice Address - Country:US
Practice Address - Phone:440-428-5707
Practice Address - Fax:440-428-3010
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health