Provider Demographics
NPI:1770210908
Name:NICOLINI, JENNIFER JILL (LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JILL
Last Name:NICOLINI
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 1:4580 HIGHWAY 158
Mailing Address - Street 2:
Mailing Address - City:HARVIELL
Mailing Address - State:MO
Mailing Address - Zip Code:63945-8144
Mailing Address - Country:US
Mailing Address - Phone:573-872-0206
Mailing Address - Fax:
Practice Address - Street 1:4580 HIGHWAY 158
Practice Address - Street 2:
Practice Address - City:HARVIELL
Practice Address - State:MO
Practice Address - Zip Code:63945-8144
Practice Address - Country:US
Practice Address - Phone:573-872-0206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021011705101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor