Healthcare Provider Details

I. General information

NPI: 1033624259
Provider Name (Legal Business Name): JENNIFER LOUISE PETTIT M. ED., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7335 YANKEE RD STE 100
LIBERTY TOWNSHIP OH
45044-0007
US

IV. Provider business mailing address

4111 SHAKER RD
FRANKLIN OH
45005-5064
US

V. Phone/Fax

Practice location:
  • Phone: 513-336-6700
  • Fax: 513-398-2109
Mailing address:
  • Phone: 740-603-6079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE.1700345-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: