Healthcare Provider Details

I. General information

NPI: 1558514539
Provider Name (Legal Business Name): MARY ANN B. JEPSEN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9633 E STATE ROUTE 37 ST. JOHN NEUMANN CATHOLIC CATHOLIC CHURCH
SUNBURY OH
43074-9672
US

IV. Provider business mailing address

PO BOX 1586 COVENANT INTEGRATIVE COUNSELING SERVICES
POWELL OH
43065-1586
US

V. Phone/Fax

Practice location:
  • Phone: 614-309-2270
  • Fax: 614-436-6884
Mailing address:
  • Phone: 614-309-2270
  • Fax: 614-436-6884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE 0700010
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: