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General NPI Number Information
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NPI Number | 1891093191
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Entity Type | Individual
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Provider Name | JENNIFER CAROLINE PINK M.S. - LPC
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Gender | Female
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 201 MAIN ST
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City | BELTON
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State | MO
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Zip | 64012-2507
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Country | US
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Telephone | 816-322-4332
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Fax |
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Provider Business Mailing Address
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Address Line | 12421 HARDY ST
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City | OVERLAND PARK
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State | KS
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Zip | 66213-1444
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Country | US
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Telephone | 913-244-2696
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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 | 2009032550
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License Number State | MO
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