Jeremy J Berry, LPC

Individual provider Active NPI Professional Counselor · Plainview, TX

NPI 1104130202 · NPPES record last updated Jul 30, 2010

Key facts

NPI
1104130202
Entity type
Individual (NPI type 1)
Primary specialty
Professional Counselor 101YP2500X
License
64038 (TX)
Practice address
907 Zephyr St
Plainview, TX 79072-6727
Phone
(806) 281-8400
NPI assigned
Jul 30, 2010
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
64038TXMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Speakeasy Counseling, LLC Professional Current Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 64038 TX Yes

Addresses

Primary practice location

907 Zephyr St
Plainview, TX 79072-6727

Mailing address

907 Zephyr St
Plainview, TX 79072-6727
Phone (806) 281-8400

Other providers in Plainview, TX

All providers in Plainview, TX · Professional Counselor in Texas

Sources for this page

Verify at the official NPI Registry.