Provider Demographics
NPI:1235691700
Name:FOUTS, JON W (ACSW, LISW-S)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:W
Last Name:FOUTS
Suffix:
Gender:M
Credentials:ACSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 NEWARK GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-1436
Mailing Address - Country:US
Mailing Address - Phone:888-531-7444
Mailing Address - Fax:614-867-9889
Practice Address - Street 1:24 EAST FRONT ST STE 203
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-8357
Practice Address - Country:US
Practice Address - Phone:740-877-8115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00080771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical