MEDICARE: DR. JONATHAN J ORR PHD, 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	101Y00000X	Counselor	LPC004277	GA
2	101Y00000X	Counselor	2958	LA

General Provider Information

NPI Number	:	1639200678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN J ORR PHD, LPC, NCC

Provider Business Mailing Address
First Line	:	PO BOX 3980
Second Line	:	DEPARTMENT OF COUNSELING AND PSYCHOLOGICAL SERVICES
City	:	ATLANTA
State	:	GA
Zip	:	30302-3980
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 PRYOR ST SW
Second Line	:	ROOM 976
City	:	ATLANTA
State	:	GA
Zip	:	30303-2909
Country	:	US
Telephone Number	:	404-651-3407
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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