Provider Demographics
NPI:1073935847
Name:REVIS, JENNIFER R (MS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:REVIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:RENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1517 E ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-5485
Mailing Address - Country:US
Mailing Address - Phone:423-839-2550
Mailing Address - Fax:423-839-2552
Practice Address - Street 1:1517 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-5485
Practice Address - Country:US
Practice Address - Phone:423-839-2550
Practice Address - Fax:423-839-2552
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist