MEDICARE: DR. JERI LYNN CROWELL EDD, NCC, LPC, CTRTC

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	004984	GA

General Provider Information

NPI Number	:	1144466491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERI LYNN CROWELL EDD, NCC, LPC, CTRTC

Provider Business Mailing Address
First Line	:	1845 UPPER RIVER RD
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31211-1222
Country	:	US
Telephone Number	:	478-747-1407
Fax Number	:	478-745-7314

Provider Business Practice Location Address
First Line	:	1845 UPPER RIVER RD
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31211-1222
Country	:	US
Telephone Number	:	478-747-1407
Fax Number	:	478-745-7314

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

Provider Enumeration Date	:	12/16/2008
Last Update Date	:	04/01/2010

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