Provider Demographics
NPI:1942636436
Name:WEBER, JASON C (MED)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:C
Last Name:WEBER
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1632
Mailing Address - Country:US
Mailing Address - Phone:740-856-1463
Mailing Address - Fax:740-856-1463
Practice Address - Street 1:3 W STIMSON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2679
Practice Address - Country:US
Practice Address - Phone:740-856-1463
Practice Address - Fax:740-856-1463
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH981054101YA0400X
OHE0007373101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional