MEDICARE: MR. JEROME HOSEA GARRISON LMFT

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	106H00000X	Marriage & Family Therapist	KY-0339	KY

General Provider Information

NPI Number	:	1437289915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEROME HOSEA GARRISON LMFT

Provider Business Mailing Address
First Line	:	10506 STONEBREAKER RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-4024
Country	:	US
Telephone Number	:	502-930-3853
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 MEADOW DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-1323
Country	:	US
Telephone Number	:	502-384-6009
Fax Number	:	502-384-1002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	04/25/2023

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