MEDICARE: JT COUNSELING GROUP, LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1790116192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JT COUNSELING GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 231
Second Line	:
City	:	COLUMBIA CITY
State	:	IN
Zip	:	46725-0231
Country	:	US
Telephone Number	:	260-229-2141
Fax Number	:

Provider Business Practice Location Address
First Line	:	3558 N AIRPORT RD
Second Line	:
City	:	COLUMBIA CITY
State	:	IN
Zip	:	46725-8672
Country	:	US
Telephone Number	:	260-229-2141
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TINA L JAGGER
Credential	:	MSW, LCSW
Telephone Number	:	260-229-2141

Provider Enumeration Date	:	12/10/2013
Last Update Date	:	12/10/2013

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