Provider Demographics
NPI:1184148496
Name:KINZER, JENNIFER TULL (LPCC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:TULL
Last Name:KINZER
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 1:927 DORIS JANE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2813
Mailing Address - Country:US
Mailing Address - Phone:513-290-6148
Mailing Address - Fax:
Practice Address - Street 1:927 DORIS JANE AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2813
Practice Address - Country:US
Practice Address - Phone:513-290-6148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700393101Y00000X
OHE.2001790101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor