Provider Demographics
NPI:1033304019
Name:EAMES, JERRY SCOTT (MAC CASAC ICAADC)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:SCOTT
Last Name:EAMES
Suffix:
Gender:M
Credentials:MAC CASAC ICAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N AULT ST
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-2506
Mailing Address - Country:US
Mailing Address - Phone:660-263-7552
Mailing Address - Fax:660-263-6593
Practice Address - Street 1:501 N AULT ST
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-2506
Practice Address - Country:US
Practice Address - Phone:660-263-7552
Practice Address - Fax:660-263-6593
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO542101YA0400X
VA32304101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)