MEDICARE: MICHAEL TODD JARVIS LPC

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	101YP2500X	Professional Counselor	003463	CT

General Provider Information

NPI Number	:	1104533579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL TODD JARVIS LPC

Provider Business Mailing Address
First Line	:	5 CONCORD WAY
Second Line	:
City	:	NEW MILFORD
State	:	CT
Zip	:	06776-5746
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 CONCORD WAY
Second Line	:
City	:	NEW MILFORD
State	:	CT
Zip	:	06776-5746
Country	:	US
Telephone Number	:	203-942-8483
Fax Number	:

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

Provider Enumeration Date	:	11/03/2022
Last Update Date	:	11/03/2022

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Directions to “ MICHAEL TODD JARVIS LPC” Practice Location

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