MEDICARE: JANA EICHE LCSW

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	101YM0800X	Mental Health Counselor	948	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000077349	OTHER	KY	BLUE CROSS

General Provider Information

NPI Number	:	1073620860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANA EICHE LCSW

Provider Business Mailing Address
First Line	:	PO BOX 221676
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40252-1676
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8521 LAGRANGE RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40242-3800
Country	:	US
Telephone Number	:	502-814-3573
Fax Number	:	502-814-7575

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	10/31/2007

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Directions to “ JANA EICHE LCSW” Practice Location

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