Provider Demographics
NPI:1700299898
Name:HINES, JENNELLE (LLP, LLPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNELLE
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:LLP, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 HOLIDAY TER STE 200A
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2161
Mailing Address - Country:US
Mailing Address - Phone:269-520-0035
Mailing Address - Fax:269-520-0051
Practice Address - Street 1:5400 HOLIDAY TER STE 200A
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2161
Practice Address - Country:US
Practice Address - Phone:269-520-0035
Practice Address - Fax:269-520-0051
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015621103TC1900X
MI6401014080101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling