Healthcare Provider Details

I. General information

NPI: 1457850588
Provider Name (Legal Business Name): JESSICA ANN JUNG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 10/27/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 E MOUND ST STE 110
COLUMBUS OH
43215-5596
US

IV. Provider business mailing address

623 PARK MEADOW RD STE H
WESTERVILLE OH
43081-2876
US

V. Phone/Fax

Practice location:
  • Phone: 614-948-3273
  • Fax: 855-740-2025
Mailing address:
  • Phone: 614-948-3273
  • Fax: 855-740-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2305579
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.018446
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: