Provider Demographics
NPI:1063616795
Name:JENNINGS, DAVID ELLIS JR (MA, LPCC, LICDC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ELLIS
Last Name:JENNINGS
Suffix:JR
Gender:M
Credentials:MA, LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8595 BEECHMONT AVENUE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255
Mailing Address - Country:US
Mailing Address - Phone:513-240-8558
Mailing Address - Fax:513-741-3589
Practice Address - Street 1:8595 BEECHMONT AVENUE
Practice Address - Street 2:SUITE 303
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255
Practice Address - Country:US
Practice Address - Phone:513-240-8558
Practice Address - Fax:513-741-3589
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0016706104100000X
OH882422-CS101YA0400X
OHE. 0016706101YM0800X
OHE0016706101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)