Provider Demographics
NPI:1710961933
Name:PRECIPHS, JESSE (PHD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:PRECIPHS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S MAIN ST
Mailing Address - Street 2:SUITE1130
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2414
Mailing Address - Country:US
Mailing Address - Phone:937-223-1612
Mailing Address - Fax:937-223-3026
Practice Address - Street 1:211 S MAIN ST
Practice Address - Street 2:SUITE1130
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2414
Practice Address - Country:US
Practice Address - Phone:937-223-1612
Practice Address - Fax:937-223-3026
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3557103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPRCP31091Medicare PIN