Healthcare Provider Details

I. General information

NPI: 1265091177
Provider Name (Legal Business Name): JENNIFER L HURSEY-AVON LPC, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L HURSEY

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W 3RD ST
DOVER OH
44622-2934
US

IV. Provider business mailing address

130 W 3RD ST
DOVER OH
44622-2934
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-6600
  • Fax: 330-343-6405
Mailing address:
  • Phone: 330-343-6600
  • Fax: 330-343-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.0900420
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: