Provider Demographics
NPI:1134333875
Name:ERNST, JEREMY WADE (LPC)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:WADE
Last Name:ERNST
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 LIBERTY ST NE STE 102
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2450
Mailing Address - Country:US
Mailing Address - Phone:513-444-8779
Mailing Address - Fax:541-440-3554
Practice Address - Street 1:880 LIBERTY ST NE STE 102
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2450
Practice Address - Country:US
Practice Address - Phone:513-444-8779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health