Provider Demographics
NPI:1730592882
Name:FANDRAY, JENNIFER KOEHLER (LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KOEHLER
Last Name:FANDRAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:MUNHALL
Mailing Address - State:PA
Mailing Address - Zip Code:15120-3423
Mailing Address - Country:US
Mailing Address - Phone:412-559-9907
Mailing Address - Fax:
Practice Address - Street 1:3712 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MUNHALL
Practice Address - State:PA
Practice Address - Zip Code:15120-3234
Practice Address - Country:US
Practice Address - Phone:412-559-9907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA000358101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional