Provider Demographics
NPI:1275212565
Name:COYLEWRIGHT, JEREMY (MSED, JD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:COYLEWRIGHT
Suffix:
Gender:M
Credentials:MSED, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 MARLIN RD STE 3800
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5651
Mailing Address - Country:US
Mailing Address - Phone:423-521-5678
Mailing Address - Fax:
Practice Address - Street 1:5721 MARLIN RD STE 3800
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5651
Practice Address - Country:US
Practice Address - Phone:423-521-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health