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NPI Code Detail

MEDICARE: HOLLY SCOTT-JACKSON LICDC

MEDICARE: HOLLY SCOTT-JACKSON LICDC
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
1390200000XStudent in an Organized Health Care Education/Training ProgramC.2506595-TRNEOH
2101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.162923OH
3101YA0400XAddiction (Substance Use Disorder) CounselorLCDCIII.162756OH

General Provider Information

NPI Number : 1356158349
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY SCOTT-JACKSON LICDC
Provider Business Mailing Address
First Line : 4600 MONTGOMERY RD STE 400
Second Line :
City : CINCINNATI
State : OH
Zip : 45212-2600
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 446 MORGAN ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45206-2348
Country : US
Telephone Number : 833-510-4357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2024
Last Update Date : 03/02/2026

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Directions to “ HOLLY SCOTT-JACKSON LICDC” Practice Location

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