Provider Demographics
NPI:1770785917
Name:KINSEY, JON M (MS, LMHC)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:M
Last Name:KINSEY
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 LIVE OAK AVE E
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435-2422
Mailing Address - Country:US
Mailing Address - Phone:850-951-0616
Mailing Address - Fax:850-892-3440
Practice Address - Street 1:267 US HIGHWAY 90 E
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-7303
Practice Address - Country:US
Practice Address - Phone:850-496-5043
Practice Address - Fax:850-892-3440
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9133OtherBLUE CROSS/BLUE SHIELD OF FL
FLZ9133OtherBLUE CROSS/BLUE SHIELD OF FL