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NPI Code Detail

MEDICARE: JEREMY WAYNE CASE MA, LPC

MEDICARE: JEREMY WAYNE CASE MA, 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
1101YP2500XProfessional Counselor2021018466MO

General Provider Information

NPI Number : 1154884146
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY WAYNE CASE MA, LPC
Provider Business Mailing Address
First Line : 6335 W JUNGE BLVD
Second Line :
City : JOPLIN
State : MO
Zip : 64804-8031
Country : US
Telephone Number : 620-202-3110
Fax Number :
Provider Business Practice Location Address
First Line : 105 E ASH ST
Second Line :
City : COLUMBIA
State : MO
Zip : 65203-4094
Country : US
Telephone Number : 573-777-7530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2019
Last Update Date : 03/14/2025

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