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NPI Code Detail

MEDICARE: MR. EUGENE JIMERSON COUNSELOR

MEDICARE: MR. EUGENE JIMERSON COUNSELOR
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
161852OTHERCAAC BHCS CLINICIAN#

General Provider Information

NPI Number : 1255536470
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EUGENE JIMERSON COUNSELOR
Provider Business Mailing Address
First Line : 1249 SCOTT ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94115-4008
Country : US
Telephone Number : 415-922-2376
Fax Number :
Provider Business Practice Location Address
First Line : 1249 SCOTT ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94115-4008
Country : US
Telephone Number : 415-922-9104
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2007
Last Update Date : 05/14/2014

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Directions to “ MR. EUGENE JIMERSON COUNSELOR” Practice Location

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