MEDICARE: JEREMY ALONZO CLAUSELL

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	ALC02473	AL

General Provider Information

NPI Number	:	1760377865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY ALONZO CLAUSELL

Provider Business Mailing Address
First Line	:	2702 NEWPORT RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36111-2920
Country	:	US
Telephone Number	:	704-352-1722
Fax Number	:	704-352-1722

Provider Business Practice Location Address
First Line	:	2702 NEWPORT RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36111-2920
Country	:	US
Telephone Number	:	704-352-1722
Fax Number	:	704-352-1722

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

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	06/10/2025

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