Provider Demographics
NPI:1003398504
Name:SMITH, JESSICA LEANN (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 BROOKRIDGE TRL # 172
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4779
Mailing Address - Country:US
Mailing Address - Phone:270-366-9363
Mailing Address - Fax:
Practice Address - Street 1:210 25TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1606
Practice Address - Country:US
Practice Address - Phone:615-933-8772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4353101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health