Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 262441 | KY |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1124651617 |
---|---|
Provider Name | Jason Scruggs |
First Address | Bowling Green, KY 42103-7956 |
Second Address | Bowling Green, KY 42101-1737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2020 |
Last Update Date | 13/04/2020 |