Healthcare Provider Details

I. General information

NPI: 1184253734
Provider Name (Legal Business Name): JASON NICHOLAS JOSEPH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4245 N. CENTRAL EXPY #490
DALLAS TX
75205-4231
US

IV. Provider business mailing address

4245 N CENTRAL EXPY STE 490
DALLAS TX
75205-4231
US

V. Phone/Fax

Practice location:
  • Phone: 214-600-4830
  • Fax:
Mailing address:
  • Phone: 214-600-4830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16108
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: