Healthcare Provider Details

I. General information

NPI: 1073848750
Provider Name (Legal Business Name): JERALYN RENEE THARP LPCC-S LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8139 OLD TROY PIKE # 1031
HUBER HEIGHTS OH
45424-1067
US

IV. Provider business mailing address

8139 OLD TROY PIKE # 1031
HUBER HEIGHTS OH
45424-1067
US

V. Phone/Fax

Practice location:
  • Phone: 937-712-5893
  • Fax: 937-962-6210
Mailing address:
  • Phone: 937-712-5893
  • Fax: 937-962-6210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1800797
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1800797
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: