Provider Demographics
NPI:1225857105
Name:KERNER COUNSELING AND CONSULTATION GROUP
Entity type:Organization
Organization Name:KERNER COUNSELING AND CONSULTATION GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:KERNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, NCC
Authorized Official - Phone:208-589-3610
Mailing Address - Street 1:1382 N 1200 E
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274-5151
Mailing Address - Country:US
Mailing Address - Phone:208-589-3610
Mailing Address - Fax:
Practice Address - Street 1:1382 N 1200 E
Practice Address - Street 2:
Practice Address - City:SHELLEY
Practice Address - State:ID
Practice Address - Zip Code:83274-5151
Practice Address - Country:US
Practice Address - Phone:208-589-3610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty