Individual
JACOB AXEL PONIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
17 S 4TH AVE, CLARION, PA 16214-1376
(814) 227-7953
Mailing address
152 SCHILL LN, LUCINDA, PA 16235-3236
(814) 327-5758
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PC017013
PA
Other
Enumeration date
04/12/2024
Last updated
04/12/2024
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