Provider Demographics
NPI:1528079761
Name:KIPNESS, JANNA (LPCC)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:
Last Name:KIPNESS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 CAMINO SAN PATRICIO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5819
Mailing Address - Country:US
Mailing Address - Phone:505-474-5550
Mailing Address - Fax:
Practice Address - Street 1:2560 CAMINO SAN PATRICIO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5819
Practice Address - Country:US
Practice Address - Phone:505-474-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3188101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health