Basic Information
| Provider Information | |||||||||
| NPI: | 1265056253 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRATT | ||||||||
| FirstName: | JAYSON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 E STATE ST STE D | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457011870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402494514 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3012 GLENMORE AVE STE 14 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452382258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178405774 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2020 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.