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NPI Code Detail

MEDICARE: JEROD MITCHELL THOMAS CADC

MEDICARE: JEROD MITCHELL THOMAS CADC
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) Counselor166725KY

General Provider Information

NPI Number : 1396202727
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEROD MITCHELL THOMAS CADC
Provider Business Mailing Address
First Line : 635 MAXWELTON CT
Second Line :
City : LEXINGTON
State : KY
Zip : 40508-4012
Country : US
Telephone Number : 859-252-1939
Fax Number :
Provider Business Practice Location Address
First Line : 635 MAXWELTON CT
Second Line :
City : LEXINGTON
State : KY
Zip : 40508-4012
Country : US
Telephone Number : 859-252-1939
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2019
Last Update Date : 02/21/2019

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