Provider Demographics
NPI:1174940647
Name:KEARNS, JENNIFER DIANE (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIANE
Last Name:KEARNS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 W CAPRI DR
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-9396
Mailing Address - Country:US
Mailing Address - Phone:573-631-1516
Mailing Address - Fax:
Practice Address - Street 1:210 E HIGH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1909
Practice Address - Country:US
Practice Address - Phone:573-631-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-23
Last Update Date:2014-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007018871101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional