MEDICARE: JARETT THOMPSON

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1891221354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARETT THOMPSON

Provider Business Mailing Address
First Line	:	235 E COMMERCIAL BLVD STE 207
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-4452
Country	:	US
Telephone Number	:	786-326-2268
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 E COMMERCIAL BLVD STE 207
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-4452
Country	:	US
Telephone Number	:	786-326-2268
Fax Number	:

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

Provider Enumeration Date	:	05/03/2017
Last Update Date	:	05/03/2017

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Directions to “ JARETT THOMPSON ” Practice Location

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