Jeremy D Vanderpool, COUNSELOR TRAINEE

Primary specialty

CounselorTaxonomy code 101Y00000X

License

C.1901668-TRNE Issued in OH

Practice address

50 Greenwood LN
Springboro, OH 45066-3033

Phone

(937) 746-1154

Fax

(937) 746-8523

NPI assigned

Dec 19, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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 and National Provider Directory roles.

• Psychological & Behavioral Consultants, LLC

  • Psychiatry Physician
  • Beachwood, OH
  • NPI 1811915713
  NPD (past)

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

{
    "created_epoch": "1513641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559865600000",
    "number": "1871009449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 COOK RD STE 400",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450369600",
            "telephone_number": "513-228-7800",
            "fax_number": "513-725-2231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 GREENWOOD LN",
            "city": "SPRINGBORO",
            "state": "OH",
            "postal_code": "450663033",
            "telephone_number": "937-746-1154",
            "fax_number": "937-746-8523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERPOOL",
        "first_name": "JEREMY",
        "middle_name": "D",
        "credential": "COUNSELOR TRAINEE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-12-19",
        "last_updated": "2019-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.151540",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "C.1901668-TRNE",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Counselor in Springboro, OH
• Providers in Springboro, OH by specialty
• Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2019; 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.