MEDICARE: JEREMIAH COON

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	101YM0800X	Mental Health Counselor	05260	KS

General Provider Information

NPI Number	:	1932861846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMIAH COON

Provider Business Mailing Address
First Line	:	300 NORTH ST
Second Line	:
City	:	TOWANDA
State	:	KS
Zip	:	67144-8846
Country	:	US
Telephone Number	:	316-641-0173
Fax Number	:

Provider Business Practice Location Address
First Line	:	8080 E CENTRAL AVE STE 190
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-2389
Country	:	US
Telephone Number	:	316-260-3777
Fax Number	:

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

Provider Enumeration Date	:	10/07/2021
Last Update Date	:	01/01/2026

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Directions to “ JEREMIAH COON ” Practice Location

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