Provider Demographics
NPI:1225538283
Name:CASTNER, JENNIFER R
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:CASTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 WEATHERLY DR
Mailing Address - Street 2:STE F
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8942
Mailing Address - Country:US
Mailing Address - Phone:931-494-7131
Mailing Address - Fax:931-548-1776
Practice Address - Street 1:298 WARFIELD BLVD STE B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-1828
Practice Address - Country:US
Practice Address - Phone:931-494-7131
Practice Address - Fax:931-548-1776
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health