Provider Demographics
NPI:1275715450
Name:LEVY, JACOB JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:JOSEPH
Last Name:LEVY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 HUXLEY RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3185
Mailing Address - Country:US
Mailing Address - Phone:865-789-8362
Mailing Address - Fax:
Practice Address - Street 1:11808 KINGSTON PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3803
Practice Address - Country:US
Practice Address - Phone:865-392-5753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2780103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling