Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003213836 |
---|---|
Provider Name | Jerri Nixon |
First Address | Somerset, KY 42501-3223 |
Second Address | Columbia, KY 42728-1915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2014 |
Last Update Date | 07/06/2019 |