Jack Waters, LCDC-III, QMHS

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LCDCIII.161114 Issued in OH

Practice address

15221 State Route 772
Piketon, OH 45661

Phone

(740) 493-4260

NPI assigned

Sep 15, 2017

Last updated

Sep 15, 2017By 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.

• Pike County Recovery Council Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waverly, OH
  • NPI 1760742993
  NPD (past)

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

{
    "created_epoch": "1505433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505433600000",
    "number": "1952820482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4431 MAPLE GROVE RD",
            "city": "CHILLICOTHE",
            "state": "OH",
            "postal_code": "456018890",
            "telephone_number": "740-703-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15221 STATE ROUTE 772",
            "city": "PIKETON",
            "state": "OH",
            "postal_code": "45661",
            "telephone_number": "740-493-4260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "JACK",
        "credential": "LCDC-III, QMHS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-15",
        "last_updated": "2017-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LCDCIII.161114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Veach, LPN
• Vanessa Marie Waddle, LPTA
• Ashley Wagner, RT(R)
• Stephen Edward Wallingford
• Darlene Ward
• Lori A Watson, QMHS
• Elyse Waugh, CDCA
• Rhonda Webb
• Cody Allan Webber
• Doris Jean Webber

• Addiction (Substance Use Disorder) Counselor in Piketon, OH
• Providers in Piketon, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2017; 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.