Provider Demographics
NPI:1336436856
Name:COON, JENNY MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:MARIE
Last Name:COON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3976 SARATOGA CT
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-3045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 FORUM BLVD
Practice Address - Street 2:STE G
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6343
Practice Address - Country:US
Practice Address - Phone:573-446-9665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008009341101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional