Healthcare Provider Details

I. General information

NPI: 1689210239
Provider Name (Legal Business Name): JESSICA R GINTHER MA, PLPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 NE CHIPMAN RD
LEES SUMMIT MO
64063-2404
US

IV. Provider business mailing address

204 NE CHIPMAN RD
LEES SUMMIT MO
64063-2404
US

V. Phone/Fax

Practice location:
  • Phone: 816-682-1590
  • Fax:
Mailing address:
  • Phone: 816-682-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2019040727
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2019040727
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: