MEDICARE: JAZZ & COCO LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1376191098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAZZ & COCO LLC

Provider Business Mailing Address
First Line	:	289 HIGHWAY 90 E UNIT H
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-9298
Country	:	US
Telephone Number	:	843-685-0998
Fax Number	:	843-695-7681

Provider Business Practice Location Address
First Line	:	289 HIGHWAY 90 E UNIT H
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-9298
Country	:	US
Telephone Number	:	843-685-0998
Fax Number	:	843-695-7681

Authorized Official
Title or Position	:	OWNER CLINICIAN
Name	:	MR. JAMES BRADFORD BENNETT
Credential	:	MA,LPC,NCC,MAC,LAC
Telephone Number	:	304-610-8661

Provider Enumeration Date	:	08/27/2019
Last Update Date	:	08/27/2019

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Directions to “JAZZ & COCO LLC ” Practice Location

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