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General NPI Number Information
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NPI Number | 1467423863
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Entity Type | Individual
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Provider Name | ANTHONY D JEFFERS LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 119 W MARKET ST
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City | COLUMBIA CITY
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State | IN
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Zip | 46725-2311
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Country | US
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Telephone | 260-248-8176
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Fax | 260-248-2366
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Provider Business Mailing Address
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Address Line | 850 N HARRISON ST
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City | WARSAW
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State | IN
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Zip | 46580-3163
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Country | US
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Telephone | 574-267-7169
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Fax | 574-269-3995
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34000284A
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License Number State | IN
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