MEDICARE: JERALYN RENEE THARP LPCC-S LICDC

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	E.1800797	OH
2	101YP2500X	Professional Counselor	E.1800797	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073848750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERALYN RENEE THARP LPCC-S LICDC

Provider Business Mailing Address
First Line	:	8139 OLD TROY PIKE # 1031
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-1067
Country	:	US
Telephone Number	:	937-712-5893
Fax Number	:	937-962-6210

Provider Business Practice Location Address
First Line	:	8139 OLD TROY PIKE # 1031
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-1067
Country	:	US
Telephone Number	:	937-712-5893
Fax Number	:	937-962-6210

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

Provider Enumeration Date	:	10/13/2009
Last Update Date	:	12/10/2025

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