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General NPI Number Information
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NPI Number | 1174095210
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Entity Type | Individual
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Provider Name | JENNIFER PARK
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Gender | Female
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Dates
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Enumeration Date | 12/31/2018
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Last Update Date | 12/31/2018
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Provider Practice Location Address
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Address Line | 20 S 36TH ST STE 201
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City | CAMP HILL
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State | PA
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Zip | 17011-4355
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Country | US
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Telephone | 717-301-4044
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Fax |
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Provider Business Mailing Address
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Address Line | 3456 LISBURN RD
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City | MECHANICSBURG
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State | PA
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Zip | 17055-6714
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC009563
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License Number State | PA
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