Individual
JEFFREY ALLEN SCHURGAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC-S, LICDC
Contact information
Practice address
4464 S DIXIE HWY, MIDDLETOWN, OH 45005-5464
(513) 649-8008
(513) 649-8004
Mailing address
4464 S DIXIE HWY, MIDDLETOWN, OH 45005-5464
(513) 649-8008
(513) 649-8004
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LICDC.141206
OH
101YM0800X
Mental Health Counselor
E.1100455.SUPV
OH
101YP2500X
Professional Counselor
Primary
E.1100455.SUPV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0074861
MEDICAID LEGACY NUMBER CHEMICAL DEPENDENCY
OH
01
—
0074946
MEDICAID LEGACY NUMBER MENTAL HEALTH
OH
01
—
01-0693
CARF CERTIFICATION
OH
01
—
H130910
MEDICARE GROUP PTAN
OH
Enumeration date
03/25/2015
Last updated
02/09/2017
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