Healthcare Provider Details

I. General information

NPI: 1205657905
Provider Name (Legal Business Name): JASON NOEL LMSW LPMT MTBC MARS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BURNHAM ST
CINCINNATI OH
45218-1319
US

IV. Provider business mailing address

3 BURNHAM ST
CINCINNATI OH
45218-1319
US

V. Phone/Fax

Practice location:
  • Phone: 513-608-0005
  • Fax:
Mailing address:
  • Phone: 513-608-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number13186
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: