Provider Demographics
NPI:1427194398
Name:VERNAM, JODY ELLEN (LPC)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:ELLEN
Last Name:VERNAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1184 SPRINGFIELD CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON CENTER
Mailing Address - State:PA
Mailing Address - Zip Code:16133-2210
Mailing Address - Country:US
Mailing Address - Phone:724-866-8033
Mailing Address - Fax:
Practice Address - Street 1:1184 SPRINGFIELD CHURCH RD
Practice Address - Street 2:
Practice Address - City:JACKSON CENTER
Practice Address - State:PA
Practice Address - Zip Code:16133-2210
Practice Address - Country:US
Practice Address - Phone:724-866-8033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004344101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102297262Medicaid
PA1973158OtherHIGHMARK