Provider Demographics
NPI:1528503067
Name:MOGUS, JASON (LPCC, LICDC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MOGUS
Suffix:
Gender:M
Credentials:LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 W LISBON ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44688-9354
Mailing Address - Country:US
Mailing Address - Phone:330-826-1430
Mailing Address - Fax:330-493-1154
Practice Address - Street 1:180 W LISBON ST
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:OH
Practice Address - Zip Code:44688-9354
Practice Address - Country:US
Practice Address - Phone:330-826-1430
Practice Address - Fax:330-493-1154
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.161082101YA0400X
390200000X
OHE.2001870101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program