Provider Demographics
NPI:1780807073
Name:DELANCEY, JASON S (PCCS, CCDC - I)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:S
Last Name:DELANCEY
Suffix:
Gender:M
Credentials:PCCS, CCDC - I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 CIRCULAR ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-3000
Mailing Address - Country:US
Mailing Address - Phone:419-443-8983
Mailing Address - Fax:
Practice Address - Street 1:817 KILBOURNE ST
Practice Address - Street 2:SUITE G
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9431
Practice Address - Country:US
Practice Address - Phone:419-483-9411
Practice Address - Fax:419-483-9247
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001431101YA0400X
OHE0003750101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health