Provider Demographics
NPI:1083195143
Name:GINES, JASON ELLIOTT (MED, MDIV, PHD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ELLIOTT
Last Name:GINES
Suffix:
Gender:M
Credentials:MED, MDIV, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16804-0594
Mailing Address - Country:US
Mailing Address - Phone:814-232-1962
Mailing Address - Fax:
Practice Address - Street 1:315 S ALLEN ST STE 326
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4851
Practice Address - Country:US
Practice Address - Phone:814-419-0781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor