Provider Demographics
NPI:1669728606
Name:RYCHNOVSKY, JENISE ELIZABETH (LMHC)
Entity type:Individual
Prefix:MRS
First Name:JENISE
Middle Name:ELIZABETH
Last Name:RYCHNOVSKY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 6TH AVE
Mailing Address - Street 2:UNIT 1102
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-2407
Mailing Address - Country:US
Mailing Address - Phone:515-988-7282
Mailing Address - Fax:
Practice Address - Street 1:5415 NW 88TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2950
Practice Address - Country:US
Practice Address - Phone:515-727-1338
Practice Address - Fax:515-727-1340
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001255101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health