Provider Demographics
NPI:1033756408
Name:PORCH, JAMIE (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:PORCH
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 1:1509 HUNT CLUB BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-6049
Mailing Address - Country:US
Mailing Address - Phone:615-336-6276
Mailing Address - Fax:
Practice Address - Street 1:1509 HUNT CLUB BLVD STE 600
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6049
Practice Address - Country:US
Practice Address - Phone:615-336-6276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4068101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health