Provider Demographics
NPI:1568841450
Name:MORING, JASON (BA, CDCA)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:MORING
Suffix:
Gender:M
Credentials:BA, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 STIRRUP LN APT P8
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-1679
Mailing Address - Country:US
Mailing Address - Phone:418-360-1167
Mailing Address - Fax:
Practice Address - Street 1:5151 MONROE ST
Practice Address - Street 2:STE 200
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3462
Practice Address - Country:US
Practice Address - Phone:419-475-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-25
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.120045101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)