Healthcare Provider Details

I. General information

NPI: 1427965698
Provider Name (Legal Business Name): JACOB PICKERILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 CHARLESTOWN RD. BMB 187
NEW ALBANY IN
47150-9362
US

IV. Provider business mailing address

4510 CHARLESTOWN RD. BMB 187
NEW ALBANY IN
47150-9362
US

V. Phone/Fax

Practice location:
  • Phone: 859-550-0306
  • Fax:
Mailing address:
  • Phone: 859-550-0306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39006177A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: