MEDICARE: MR. JEREMY WADE ERNST 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1134333875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEREMY WADE ERNST LPC

Provider Business Mailing Address
First Line	:	880 LIBERTY ST NE STE 102
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-2450
Country	:	US
Telephone Number	:	513-444-8779
Fax Number	:	541-440-3554

Provider Business Practice Location Address
First Line	:	880 LIBERTY ST NE STE 102
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-2450
Country	:	US
Telephone Number	:	513-444-8779
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	09/11/2025

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