=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225857105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KERNER COUNSELING AND CONSULTATION GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2024
-----------------------------------------------------
Last Update Date | 10/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1382 N 1200 E
-----------------------------------------------------
City | SHELLEY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83274-5151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-589-3610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1382 N 1200 E
-----------------------------------------------------
City | SHELLEY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83274-5151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-589-3610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | JENNIFER DEE KERNER
-----------------------------------------------------
Credential | LCPC, NCC
-----------------------------------------------------
Telephone | 208-589-3610
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------