Provider Demographics
NPI:1154884146
Name:CASE, JEREMY WAYNE (MA, LPC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:WAYNE
Last Name:CASE
Suffix:
Gender:
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6335 W JUNGE BLVD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-8031
Mailing Address - Country:US
Mailing Address - Phone:620-202-3110
Mailing Address - Fax:
Practice Address - Street 1:105 E ASH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4094
Practice Address - Country:US
Practice Address - Phone:573-777-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021018466101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional