Provider Demographics
NPI:1043392269
Name:MATTHAI, JENNY M (EDD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:M
Last Name:MATTHAI
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 WATSONWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211
Mailing Address - Country:US
Mailing Address - Phone:615-604-7000
Mailing Address - Fax:
Practice Address - Street 1:571 WATSONWOOD DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5320
Practice Address - Country:US
Practice Address - Phone:615-604-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNHSP 1753101YM0800X
TNP1753103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4070500OtherBCBS - NONPARTICIPATING
TN3983054Medicaid
TN3983054Medicare ID - Type UnspecifiedPARTICIPATING PROVIDER