Healthcare Provider Details

I. General information

NPI: 1386174647
Provider Name (Legal Business Name): CLARA KINNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 06/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 E 10TH ST
JEFFERSONVILLE IN
47130-7303
US

IV. Provider business mailing address

2420 E 10TH ST
JEFFERSONVILLE IN
47130-7303
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-8248
  • Fax: 812-206-8289
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: