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General NPI Number Information
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NPI Number | 1073878799
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Entity Type | Individual
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Provider Name | JESSICA ANN KYNION HOLLAND LPCC-S
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Gender | Female
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 312 3RD ST
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City | ELYRIA
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State | OH
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Zip | 44035-5618
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Country | US
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Telephone | 440-323-5707
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Fax |
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Provider Business Mailing Address
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Address Line | 2248 GARDEN DR
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City | AVON
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State | OH
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Zip | 44011-2609
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Country | US
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Telephone | 740-438-1762
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.1100550-TRNE
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E.1100550-S
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License Number State | OH
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