Provider Demographics
NPI:1972818847
Name:WOLFE, JEREMEY (LCSW)
Entity Type:Individual
Prefix:
First Name:JEREMEY
Middle Name:
Last Name:WOLFE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6304 CASTLE HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-6001
Mailing Address - Country:US
Mailing Address - Phone:417-291-4386
Mailing Address - Fax:
Practice Address - Street 1:6304 CASTLE HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-6001
Practice Address - Country:US
Practice Address - Phone:417-291-4386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090378251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical