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NPI Code Detail

MEDICARE: JASON GARRY MA

MEDICARE: JASON GARRY MA
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 Counselor

General Provider Information

NPI Number : 1427591114
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON GARRY MA
Provider Business Mailing Address
First Line : 13024 GREEN VALLEY RD
Second Line :
City : SEBASTOPOL
State : CA
Zip : 95472-9336
Country : US
Telephone Number : 347-403-0820
Fax Number :
Provider Business Practice Location Address
First Line : 202 PROVIDENCE MINE RD STE 105
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-2945
Country : US
Telephone Number : 530-265-7844
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2016
Last Update Date : 01/05/2017

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