Provider Demographics
NPI:1720325244
Name:KITCHENS, JENIFER (LPC)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:KITCHENS
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 1:19 W CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:HOMEDALE
Mailing Address - State:ID
Mailing Address - Zip Code:83628-3030
Mailing Address - Country:US
Mailing Address - Phone:208-697-4836
Mailing Address - Fax:
Practice Address - Street 1:19 W CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:HOMEDALE
Practice Address - State:ID
Practice Address - Zip Code:83628-3030
Practice Address - Country:US
Practice Address - Phone:208-697-4836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health