Provider Demographics
NPI:1639289085
Name:FOUTS, JACK (MSED)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:
Last Name:FOUTS
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 S 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2143
Mailing Address - Country:US
Mailing Address - Phone:412-381-2100
Mailing Address - Fax:412-381-2004
Practice Address - Street 1:70 S 22ND ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-2143
Practice Address - Country:US
Practice Address - Phone:412-381-2100
Practice Address - Fax:412-381-2004
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)