MEDICARE: JASON SMITH ASSESSMENT AND COUNSELING ASSOCIATES

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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1417507872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASON SMITH ASSESSMENT AND COUNSELING ASSOCIATES

Provider Business Mailing Address
First Line	:	950 OFFICE PARK RD STE 235
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-2121
Country	:	US
Telephone Number	:	515-419-1742
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 OFFICE PARK RD STE 235
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-2121
Country	:	US
Telephone Number	:	515-419-1742
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASON W SMITH
Credential	:	PSY.D
Telephone Number	:	515-419-1742

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	12/05/2019

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