Provider Demographics
NPI:1154919116
Name:KOHNEN, DESTINI JAZZMYN (LMHC)
Entity type:Individual
Prefix:
First Name:DESTINI
Middle Name:JAZZMYN
Last Name:KOHNEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 PLEASANT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-2473
Mailing Address - Country:US
Mailing Address - Phone:508-697-1070
Mailing Address - Fax:
Practice Address - Street 1:1029 PLEASANT ST STE 101
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-2473
Practice Address - Country:US
Practice Address - Phone:508-697-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12117-MH-CC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health