Provider Demographics
NPI:1508215658
Name:BERL, JASON
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:BERL
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 1:104 BORDERS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8975
Mailing Address - Country:US
Mailing Address - Phone:478-387-8937
Mailing Address - Fax:
Practice Address - Street 1:104 BORDERS WAY STE 200
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8975
Practice Address - Country:US
Practice Address - Phone:478-387-8937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004721101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional