Provider Demographics
NPI:1265091177
Name:HURSEY-AVON, JENNIFER L (LPC, LSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:HURSEY-AVON
Suffix:
Gender:F
Credentials:LPC, LSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:HURSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2934
Mailing Address - Country:US
Mailing Address - Phone:330-343-6600
Mailing Address - Fax:330-343-6405
Practice Address - Street 1:130 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2934
Practice Address - Country:US
Practice Address - Phone:330-343-6600
Practice Address - Fax:330-343-6405
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0900420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional