Healthcare Provider Details

I. General information

NPI: 1235690975
Provider Name (Legal Business Name): JENNIFER NITZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4633 AICHOLTZ RD
CINCINNATI OH
45244-1447
US

IV. Provider business mailing address

4629 AICHOLTZ RD STE 2
CINCINNATI OH
45244-1560
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-1555
  • Fax:
Mailing address:
  • Phone: 513-752-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number246148
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2204691
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: