Individual
JENNIFER WILZ MAHANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC-S
Contact information
Practice address
1401 MADISON AVE, COVINGTON, KY 41011-3313
(859) 655-6100
(859) 655-6179
Mailing address
215 E 11TH ST, NEWPORT, KY 41071-2203
(859) 655-6100
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
103061
KY
101YP2500X
Professional Counselor
1438
KY
101YP2500X
Professional Counselor
E.0004240-SUPV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
610661458
TAX ID
KY
Enumeration date
09/11/2012
Last updated
08/12/2024
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