Provider Demographics
NPI:1124651617
Name:SCRUGGS, JASON (LPCC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SCRUGGS
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GARLAND CT
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-5400
Mailing Address - Country:US
Mailing Address - Phone:270-535-1209
Mailing Address - Fax:270-842-5268
Practice Address - Street 1:408 HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-9201
Practice Address - Country:US
Practice Address - Phone:270-535-1209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY276398101YP2500X
KY262441101Y00000X
225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor