Provider Demographics
NPI:1700291192
Name:WHITTEN, JENNIFER (LPCC-SUPV)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WHITTEN
Suffix:
Gender:F
Credentials:LPCC-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16512 WESTDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-4222
Mailing Address - Country:US
Mailing Address - Phone:216-333-2507
Mailing Address - Fax:
Practice Address - Street 1:2500 AVON BELDEN RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:OH
Practice Address - Zip Code:44044-9802
Practice Address - Country:US
Practice Address - Phone:440-748-5474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0008322101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health