Provider Demographics
NPI:1013359660
Name:DYE, JACOB DANIEL (MS)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:DANIEL
Last Name:DYE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9053 COUCHVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7615
Mailing Address - Country:US
Mailing Address - Phone:615-900-7267
Mailing Address - Fax:
Practice Address - Street 1:9053 COUCHVILLE PIKE
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-7615
Practice Address - Country:US
Practice Address - Phone:615-900-7267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3020101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional