Provider Demographics
NPI:1528137221
Name:JOYCE, JASON MACKALL (PCC-S, LCDC III)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MACKALL
Last Name:JOYCE
Suffix:
Gender:M
Credentials:PCC-S, LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-6318
Mailing Address - Country:US
Mailing Address - Phone:740-317-3997
Mailing Address - Fax:
Practice Address - Street 1:6811 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-6318
Practice Address - Country:US
Practice Address - Phone:740-317-3997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YA0400X
OHC-0500521101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)