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NPI Code Detail

MEDICARE: JERRITT WAYNE TODD LPC

MEDICARE: JERRITT WAYNE TODD 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
1101YM0800XMental Health Counselor80453TX

General Provider Information

NPI Number : 1972101194
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRITT WAYNE TODD LPC
Provider Business Mailing Address
First Line : 2011 PALO ALTO DR
Second Line :
City : CARROLLTON
State : TX
Zip : 75006-3111
Country : US
Telephone Number : 214-549-8979
Fax Number :
Provider Business Practice Location Address
First Line : 4801 MEDICAL CENTER DR
Second Line :
City : MCKINNEY
State : TX
Zip : 75069-1881
Country : US
Telephone Number : 469-714-0006
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2020
Last Update Date : 10/19/2022

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