Healthcare Provider Details

I. General information

NPI: 1770944142
Provider Name (Legal Business Name): JEREMY HUNT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST
DANSVILLE NY
14437-1709
US

IV. Provider business mailing address

1 MAIN ST
DANSVILLE NY
14437-1709
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-4316
  • Fax: 585-335-3577
Mailing address:
  • Phone: 585-335-4316
  • Fax: 585-335-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: