MEDICARE: ERIN DAWN JARRETT MFTA, LSGC, TCADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	172920	KY
2	101YS0200X	School Counselor	201195131	KY
3	106H00000X	Marriage & Family Therapist	175245	KY

General Provider Information

NPI Number	:	1043710338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN DAWN JARRETT MFTA, LSGC, TCADC

Provider Business Mailing Address
First Line	:	1939 GOLDSMITH LN STE 147
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-3047
Country	:	US
Telephone Number	:	502-821-0091
Fax Number	:

Provider Business Practice Location Address
First Line	:	1939 GOLDSMITH LN STE 147
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-3047
Country	:	US
Telephone Number	:	502-821-0091
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2018
Last Update Date	:	02/13/2018

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