MEDICARE: JASON MICHAEL CATOUR LPC STUDENT

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1639033566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON MICHAEL CATOUR LPC STUDENT

Provider Business Mailing Address
First Line	:	50 ORCHARD DR
Second Line	:
City	:	ELGIN
State	:	SC
Zip	:	29045-9869
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 FORT JACKSON BLVD STE 110
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1134
Country	:	US
Telephone Number	:	803-800-1868
Fax Number	:

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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