MEDICARE: ZYNASIA JASPER MS. LPC, NCC

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	101YM0800X	Mental Health Counselor	8912	NC

General Provider Information

NPI Number	:	1518202498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZYNASIA JASPER MS. LPC, NCC

Provider Business Mailing Address
First Line	:	304 W FISHER AVE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-2044
Country	:	US
Telephone Number	:	336-285-7173
Fax Number	:	336-285-7174

Provider Business Practice Location Address
First Line	:	304 W FISHER AVE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-2044
Country	:	US
Telephone Number	:	336-285-7173
Fax Number	:	336-285-7174

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

Provider Enumeration Date	:	12/04/2012
Last Update Date	:	10/22/2013

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