MEDICARE: JASON SCRUGGS LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	276398	KY
2	101Y00000X	Counselor	262441	KY
3	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1124651617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON SCRUGGS LPCC

Provider Business Mailing Address
First Line	:	101 GARLAND CT
Second Line	:
City	:	WHITE HOUSE
State	:	TN
Zip	:	37188-5400
Country	:	US
Telephone Number	:	270-535-1209
Fax Number	:	270-842-5268

Provider Business Practice Location Address
First Line	:	408 HIGHWAY 76
Second Line	:
City	:	WHITE HOUSE
State	:	TN
Zip	:	37188-9201
Country	:	US
Telephone Number	:	270-535-1209
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	06/01/2022

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