MEDICARE: JAMIE BRUNTON CHARITY MSED, LPCC-S

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	101YP2500X	Professional Counselor	E.1100084-SUPV	OH

General Provider Information

NPI Number	:	1477890788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE BRUNTON CHARITY MSED, LPCC-S

Provider Business Mailing Address
First Line	:	116 GRANVILLE ST STE 105
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-3044
Country	:	US
Telephone Number	:	740-525-5734
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 GRANVILLE ST STE 105
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-3044
Country	:	US
Telephone Number	:	740-525-5734
Fax Number	:

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

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	06/19/2019

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