Individual
IVAN T JINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
507 TROJAN TRL, GLASGOW, KY 42141-2214
(844) 435-0900
(270) 858-4029
Mailing address
PO BOX 1080, BURKESVILLE, KY 42717-1080
(270) 858-6655
(270) 858-4607
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
247523
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14407125
CAQH
—
05
—
7100587150
—
KY
Enumeration date
09/09/2015
Last updated
09/01/2023
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