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General NPI Number Information
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NPI Number | 1588373823
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Entity Type | Individual
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Provider Name | GLORIA JEAN KINNEY L.P.C., C.R.C
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Gender | Female
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Dates
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Enumeration Date | 11/15/2022
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 3095 KETTERING BLVD
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City | MORAINE
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State | OH
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Zip | 45439-1983
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Country | US
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Telephone | 937-293-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 145 ROSEWOOD DR
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City | SPRINGBORO
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State | OH
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Zip | 45066-1598
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Country | US
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Telephone | 937-274-6088
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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 | 210789
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C.1700840
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License Number State | OH
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