Provider Demographics
NPI:1154552743
Name:WOOSLEY, JENNIFER (MA, LPCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WOOSLEY
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 BROOKS INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8154
Mailing Address - Country:US
Mailing Address - Phone:502-633-1315
Mailing Address - Fax:502-633-1315
Practice Address - Street 1:2121 TYLER LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2923
Practice Address - Country:US
Practice Address - Phone:502-797-3775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1271101Y00000X
KY1661101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100334590Medicaid