Healthcare Provider Details

I. General information

NPI: 1982164331
Provider Name (Legal Business Name): JACQUELYN TRIPP LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 E MAIN ST
COLUMBUS OH
43205-2035
US

IV. Provider business mailing address

2097 ELMORE AVE
COLUMBUS OH
43224-5020
US

V. Phone/Fax

Practice location:
  • Phone: 216-540-1358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0900564
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: