Healthcare Provider Details

I. General information

NPI: 1053097337
Provider Name (Legal Business Name): JONELLE MASSEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 EXECUTIVE PKWY STE 210
TOLEDO OH
43606-1327
US

IV. Provider business mailing address

2329 MEADOWWOOD DR
TOLEDO OH
43606-3158
US

V. Phone/Fax

Practice location:
  • Phone: 419-972-1114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1801309
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: