Provider Demographics
NPI:1093761538
Name:MAZZEI, JENNIFER L (MA, SPE)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:MAZZEI
Suffix:
Gender:F
Credentials:MA, SPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-0190
Mailing Address - Country:US
Mailing Address - Phone:423-596-1546
Mailing Address - Fax:423-876-1109
Practice Address - Street 1:6400 LEE HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2452
Practice Address - Country:US
Practice Address - Phone:423-899-5081
Practice Address - Fax:423-490-0410
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001513101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health