Individual
MR. CODY JAQUES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S, LPCC
Contact information
Practice address
1114 SHANNON LN, XENIA, OH 45385-2788
(937) 681-8322
Mailing address
1114 SHANNON LN, XENIA, OH 45385-2788
(937) 681-8322
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
C.1600143-TRNE
OH
101YM0800X
Mental Health Counselor
Primary
E.1901498
OH
Other
Enumeration date
03/31/2016
Last updated
12/11/2019
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