Individual
JEFFREY SHOUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 ELIZABETH PL STE NWB40, DAYTON, OH 45417-3445
(937) 401-8672
(937) 853-8029
Mailing address
1 ELIZABETH PL STE NWB40, DAYTON, OH 45417-3445
(937) 401-8672
(937) 853-8029
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OH
Other
Enumeration date
10/25/2019
Last updated
10/25/2019
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