Healthcare Provider Details

I. General information

NPI: 1760180350
Provider Name (Legal Business Name): MICHELLE JARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 PINECREST DR
GALLIPOLIS OH
45631-1347
US

IV. Provider business mailing address

254 PINECREST DR
GALLIPOLIS OH
45631-1347
US

V. Phone/Fax

Practice location:
  • Phone: 740-578-4824
  • Fax: 740-578-4821
Mailing address:
  • Phone: 740-578-4824
  • Fax: 740-578-4821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number185079
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: