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NPI Code Detail

MEDICARE: JONATHAN KINNEY LPC

MEDICARE: JONATHAN KINNEY LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor2016040024MO

General Provider Information

NPI Number : 1346518297
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN KINNEY LPC
Provider Business Mailing Address
First Line : PO BOX 459
Second Line :
City : FARMINGTON
State : MO
Zip : 63640-0459
Country : US
Telephone Number : 573-756-5749
Fax Number : 573-431-1673
Provider Business Practice Location Address
First Line : 203 N GRAND ST
Second Line :
City : SALEM
State : MO
Zip : 65560-1344
Country : US
Telephone Number : 573-729-4103
Fax Number : 573-729-4420
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2011
Last Update Date : 12/14/2016

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Directions to “ JONATHAN KINNEY LPC” Practice Location

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