Healthcare Provider Details

I. General information

NPI: 1881518553
Provider Name (Legal Business Name): JENNIFER LYN HARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S MAIN ST
LIMA OH
45804-1500
US

IV. Provider business mailing address

75 OAKBRIDGE PARK
TIFFIN OH
44883-3639
US

V. Phone/Fax

Practice location:
  • Phone: 567-371-4430
  • Fax:
Mailing address:
  • Phone: 567-371-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: