Healthcare Provider Details

I. General information

NPI: 1356524052
Provider Name (Legal Business Name): JENNA ANN FORAKER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SE DOUGLAS ST
LEES SUMMIT MO
64063-2740
US

IV. Provider business mailing address

320 SE DOUGLAS ST
LEES SUMMIT MO
64063-2740
US

V. Phone/Fax

Practice location:
  • Phone: 816-463-8458
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2008030793
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number597
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: