MEDICARE: STEPHEN JESTER LPC

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	LPC004649	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LPC004649	OTHER	GA	LICENSE

General Provider Information

NPI Number	:	1821229840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN JESTER LPC

Provider Business Mailing Address
First Line	:	7246 BLUE SPRINGS RD
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-8812
Country	:	US
Telephone Number	:	423-779-8620
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 BOMBAY LN
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-5829
Country	:	US
Telephone Number	:	423-779-8620
Fax Number	:

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

Provider Enumeration Date	:	08/07/2009
Last Update Date	:	05/26/2011

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