Provider Demographics
NPI:1427623958
Name:VAN METER, JENNIFER ELISE (MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELISE
Last Name:VAN METER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 ARMSTRONG MILL RD APT 204
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-7505
Mailing Address - Country:US
Mailing Address - Phone:502-382-7042
Mailing Address - Fax:
Practice Address - Street 1:501 DARBY CREEK RD STE 41
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1671
Practice Address - Country:US
Practice Address - Phone:502-382-7042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY248206103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical