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NPI Code Detail

MEDICARE: JEREMY SPAFFORD

MEDICARE: JEREMY SPAFFORD
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 CounselorPROFESSIONALLICENSE

General Provider Information

NPI Number : 1346525920
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY SPAFFORD
Provider Business Mailing Address
First Line : 3587 HEATHROW WAY
Second Line :
City : MEDFORD
State : OR
Zip : 97504-4004
Country : US
Telephone Number : 541-858-8170
Fax Number :
Provider Business Practice Location Address
First Line : 29398 RECOVERY WAY STE 2
Second Line :
City : JUNCTION CITY
State : OR
Zip : 97448-8447
Country : US
Telephone Number : 541-998-4574
Fax Number : 541-998-4533
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2011
Last Update Date : 04/09/2024

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