Jacob D Durham, LPCA

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

286980 Issued in KY

Practice address

647 W Highway 80 Ste 1
Somerset, KY 42503-2897

Phone

(606) 802-2880

Fax

(606) 802-2888

NPI assigned

Sep 21, 2023

Last updated

Sep 21, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Life Springs PLLC

  • Psychologist
  • Somerset, KY
  • NPI 1861924953
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1619755451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 SAND SPRINGS RD",
            "city": "MOUNT VERNON",
            "state": "KY",
            "postal_code": "404569060",
            "telephone_number": "606-392-9929",
            "fax_number": "606-802-2888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "647 W HIGHWAY 80 STE 1",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425032897",
            "telephone_number": "606-802-2880",
            "fax_number": "606-802-2888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURHAM",
        "first_name": "JACOB",
        "middle_name": "D",
        "credential": "LPCA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-21",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KY",
            "license": "286980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teya Dungan
• Weston Dungan, PHARM.D.
• William Joseph Dungan, LCSW LICENSED CLINIC
• Joseph Owen Dunkum, DMD
• Elizabeth Katherine Durham, DO
• Melissa Dye
• Misty M Dye
• Shelly Dyer
• Eadens-Grimball Internal Medicine Associates
• Debra J Eadens, MD

• Professional Counselor in Somerset, KY
• Providers in Somerset, KY by specialty
• Professional Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.