Basic Information
| Provider Information | |||||||||
| NPI: | 1083856801 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUSS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | MAE | ||||||||
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| Credential: | LPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 ROCKWOOD LN | ||||||||
| Address2: | |||||||||
| City: | HAZARD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 417019415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064365761 | ||||||||
| FaxNumber: | 6064365797 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 ROCKWOOD LN | ||||||||
| Address2: | |||||||||
| City: | HAZARD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 417019415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064365761 | ||||||||
| FaxNumber: | 6064365797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2009 | ||||||||
| LastUpdateDate: | 04/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0844 | KY | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103TC0700X | 172703 | KY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 7100462930 | 05 | KY | MEDICAID |