Tackett, Fredrick Jason

Tackett, Fredrick Jason is an sole proprietor health care provider with primary practice located at 323 Marion Pike Ste 1 , Coal Grove OH 45638-2958. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Other Service Providers / Case Manager/Care Coordinator, Other Service Providers / Peer Specialist. Other Service Providers / Peer Specialist is his primary health care specialty. Tackett, Fredrick Jason can be contacted via phone (740) 237-4981.

Contact Information

Primary practice address
323 Marion Pike Ste 1 Coal Grove OH 45638-2958
Phone: (740) 237-4981
Fax: (877) 325-2816
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Other Service Providers / Case Manager/Care Coordinator 171M00000X
Other Service Providers / Peer Specialist 175T00000X

Profile Details

NPI number 1235820051
LBN Legal business name Tackett, Fredrick Jason
Credentials APS.004051
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 15th, 2023
Last updated Jun 12th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235820051 NPPES
Ohio MEDICAID 0017298

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