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NPI Code Detail

MEDICARE: JASON NICHOLAS JOSEPH LPC

MEDICARE: JASON NICHOLAS JOSEPH 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
1101YM0800XMental Health Counselor16108TX

General Provider Information

NPI Number : 1184253734
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON NICHOLAS JOSEPH LPC
Provider Business Mailing Address
First Line : 4245 N CENTRAL EXPY STE 490
Second Line :
City : DALLAS
State : TX
Zip : 75205-4231
Country : US
Telephone Number : 214-600-4830
Fax Number :
Provider Business Practice Location Address
First Line : 4245 N. CENTRAL EXPY #490
Second Line :
City : DALLAS
State : TX
Zip : 75205-4231
Country : US
Telephone Number : 214-600-4830
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2020
Last Update Date : 12/20/2025

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