MEDICARE: JAMAR IZZARD MS, CMHC

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

General Provider Information

NPI Number	:	1528890407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMAR IZZARD MS, CMHC

Provider Business Mailing Address
First Line	:	1234 N 28TH ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19121-4536
Country	:	US
Telephone Number	:	215-432-5396
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 N 28TH ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19121-4536
Country	:	US
Telephone Number	:	215-432-5396
Fax Number	:

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

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	08/19/2024

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