MEDICARE: MR. JAY DAVID TOMPKINS LMSW

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	1041C0700X	Clinical Social Worker	6801105881	MI

General Provider Information

NPI Number	:	1437792892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAY DAVID TOMPKINS LMSW

Provider Business Mailing Address
First Line	:	333 W GRANDVIEW PKWY STE 403
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2298
Country	:	US
Telephone Number	:	231-929-0300
Fax Number	:	231-933-6378

Provider Business Practice Location Address
First Line	:	333 W GRANDVIEW PKWY STE 403
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2298
Country	:	US
Telephone Number	:	231-929-0300
Fax Number	:

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

Provider Enumeration Date	:	10/17/2019
Last Update Date	:	10/21/2019

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