Individual provider Active NPI

Jessica Ann Kynion Holland, LPCC-S

  • Mental Health Counselor
  • Elyria, OH
National Provider Identifier
1073878799
Registry record updated Mar 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
E.1100550-S Issued in OH
Practice address
312 3Rd St
Elyria, OH 44035-5618
Phone
(440) 323-5707
NPI assigned
Jul 9, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X C.1100550-TRNE OH
Mental Health Counselor 101YM0800X E.1100550-S OH Primary

Addresses

Primary practice location

312 3Rd St
Elyria, OH 44035-5618

Mailing address

2248 Garden Dr
Avon, OH 44011-2609
Phone (740) 438-1762

Other practice location 1

624 Market Ave N
Canton, OH 44702-1017
Phone (330) 454-7066

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
C.1100550-TRNEOHMDMental Health Counselor
E.1100550-SOHMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Pathways Counseling and Growth Center CurrentSince Mar 7, 2021 Accepting new patients
Pathways Counseling and Growth Center PastSince Mar 7, 2021 Accepting new patients

Locations

312 3rd St
Elyria, OH 44035
Phone (440) 323-5707

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/pathwayscounselingcenter/r4/

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614816000000",
    "number": "1073878799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2248 GARDEN DR",
            "city": "AVON",
            "state": "OH",
            "postal_code": "440112609",
            "telephone_number": "740-438-1762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 3RD ST",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440355618",
            "telephone_number": "440-323-5707"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "624 Market Ave N",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "OH",
            "postal_code": "447021017",
            "country_code": "US",
            "telephone_number": "330-454-7066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLLAND",
        "first_name": "JESSICA",
        "middle_name": "ANN KYNION",
        "credential": "LPCC-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-09",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "C.1100550-TRNE",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.1100550-S",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elyria, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.