Healthcare Provider Details

I. General information

NPI: 1295291672
Provider Name (Legal Business Name): JENNIFER K DOYLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W HICKORY ST
NEVADA MO
64772-1727
US

IV. Provider business mailing address

1601 W HICKORY ST
NEVADA MO
64772-1727
US

V. Phone/Fax

Practice location:
  • Phone: 417-667-1677
  • Fax: 417-530-1479
Mailing address:
  • Phone: 417-667-1677
  • Fax: 417-530-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2017006589
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: