Individual
MS. JAN S KIMBALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 578-8200
Mailing address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 578-8200
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
E.0008013
OH
101YP2500X
Professional Counselor
E0008013
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0187764
—
OH
Enumeration date
10/05/2016
Last updated
06/29/2021
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