Provider Demographics
NPI:1942771217
Name:VAN HOUTEN, JENNA (BS, MS, LPCC)
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:
Last Name:VAN HOUTEN
Suffix:
Gender:F
Credentials:BS, MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 HERITAGE POINT DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2007
Mailing Address - Country:US
Mailing Address - Phone:937-267-6295
Mailing Address - Fax:
Practice Address - Street 1:2030 HERITAGE POINT DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45409-2007
Practice Address - Country:US
Practice Address - Phone:937-267-6295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2302599101Y00000X
OHE.2303599101YP2500X, 171M00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator