Doctor Name: | JEROME LECAIN |
NPI Number: | 1023395050 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | B.S. |
License Number: | |
Business Practice Address: | 1920 Sw Kurtz Lane Grants Pass, OR - 975262803 |
Business Phone Number: | 5412953072 |
Business Fax Number: | 5412953074 |
Mailing Address: | 715 Sw Ramsey Ave, GRANTS PASS |
State: | OR |
Postal Code: | 975275500 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 11/04/2011 |
NPI Last Update Date: | 11/04/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |