Provider Demographics
NPI:1053828996
Name:MEYER, JESSICA LYNNE (LMHC CADAC IV)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:MEYER
Suffix:
Gender:F
Credentials:LMHC CADAC IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 STONE HILL DR
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:TN
Mailing Address - Zip Code:37348-1000
Mailing Address - Country:US
Mailing Address - Phone:219-363-8476
Mailing Address - Fax:
Practice Address - Street 1:4 STONE HILL DR
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:TN
Practice Address - Zip Code:37348-1000
Practice Address - Country:US
Practice Address - Phone:219-363-8476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-01
Last Update Date:2018-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002740A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health