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General NPI Number Information
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NPI Number | 1235482894
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Entity Type | Individual
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Provider Name | JARED KAISER LPCC-S
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Gender | Male
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 4936 OLD IRWIN SIMPSON RD
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City | MASON
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State | OH
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Zip | 45040-9751
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Country | US
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Telephone | 513-649-7458
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Fax |
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Provider Business Mailing Address
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Address Line | 1879 DEERFIELD RD
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City | LEBANON
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State | OH
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Zip | 45036-8602
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Country | US
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Telephone | 513-695-2726
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | C.1100451
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.1100451-SUPV
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License Number State | OH
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