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NPI Code Detail

MEDICARE: STEPHEN JARRELL LCSW, LCAC

MEDICARE: STEPHEN JARRELL LCSW, LCAC
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
11041C0700XClinical Social Worker34001650AIN
2101YA0400XAddiction (Substance Use Disorder) Counselor87000362AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528105202
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN JARRELL LCSW, LCAC
Provider Business Mailing Address
First Line : 2712 S CALHOUN ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46807-1402
Country : US
Telephone Number : 260-744-4326
Fax Number : 260-744-0188
Provider Business Practice Location Address
First Line : 2712 S CALHOUN ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46807-1402
Country : US
Telephone Number : 260-744-4326
Fax Number : 260-744-0188
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 09/14/2016

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