Provider Demographics
NPI:1225905938
Name:DANIEL, JENNIFER RENEE (LPCC, LCADC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENEE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:LPCC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 PEMBROKE FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:KY
Mailing Address - Zip Code:42266-9718
Mailing Address - Country:US
Mailing Address - Phone:270-305-5355
Mailing Address - Fax:
Practice Address - Street 1:4605 PEMBROKE FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:KY
Practice Address - Zip Code:42266-9718
Practice Address - Country:US
Practice Address - Phone:270-305-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY288280101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional