MEDICARE: JESSICA MOGER LAWLER MS, LMFT

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	106H00000X	Marriage & Family Therapist	3098	MN
2	106H00000X	Marriage & Family Therapist	4685	SC

General Provider Information

NPI Number	:	1225524721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MOGER LAWLER MS, LMFT

Provider Business Mailing Address
First Line	:	10 DOVE FIELD CT
Second Line	:
City	:	HOPKINS
State	:	SC
Zip	:	29061-9240
Country	:	US
Telephone Number	:	507-676-5636
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 FOREST DR STE A204
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4146
Country	:	US
Telephone Number	:	803-216-1645
Fax Number	:

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

Provider Enumeration Date	:	07/08/2018
Last Update Date	:	09/29/2023

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