Healthcare Provider Details

I. General information

NPI: 1881004620
Provider Name (Legal Business Name): JASON ALLEN GEROU LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20300 SUPERIOR RD STE 250
TAYLOR MI
48180-6342
US

IV. Provider business mailing address

20300 SUPERIOR RD STE 250
TAYLOR MI
48180-6342
US

V. Phone/Fax

Practice location:
  • Phone: 734-785-7700
  • Fax: 734-287-2074
Mailing address:
  • Phone: 734-785-7700
  • Fax: 734-287-2074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401223142
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401223142
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: