Healthcare Provider Details

I. General information

NPI: 1326257379
Provider Name (Legal Business Name): JASON MICHAEL ROPER MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 DAN AVE
OLIVEHURST CA
95961-8107
US

IV. Provider business mailing address

4240 DAN AVE
OLIVEHURST CA
95961-8107
US

V. Phone/Fax

Practice location:
  • Phone: 530-741-6275
  • Fax: 530-749-7913
Mailing address:
  • Phone: 530-741-6275
  • Fax: 530-749-7913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number060280844
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 46889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: