Provider Demographics
NPI:1609920420
Name:FRENCH, JASON VAUGHAN (LPC LSATP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:VAUGHAN
Last Name:FRENCH
Suffix:
Gender:M
Credentials:LPC LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0173
Mailing Address - Country:US
Mailing Address - Phone:434-391-4306
Mailing Address - Fax:434-392-6385
Practice Address - Street 1:2720 LAYNE STREET EXT
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-3069
Practice Address - Country:US
Practice Address - Phone:434-391-4306
Practice Address - Fax:434-392-6385
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004334101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health