Provider Demographics
NPI:1275306003
Name:COMFORT, JARED
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:COMFORT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 W TRENTON OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-1227
Mailing Address - Country:US
Mailing Address - Phone:260-336-8882
Mailing Address - Fax:
Practice Address - Street 1:2605 W TRENTON OVERLOOK
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-1227
Practice Address - Country:US
Practice Address - Phone:260-336-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010142A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical