Provider Demographics
NPI:1275800328
Name:LAVENDER, JESSICA (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LAVENDER
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 PERCY PRIEST DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3905
Mailing Address - Country:US
Mailing Address - Phone:615-584-6644
Mailing Address - Fax:
Practice Address - Street 1:3331 PERCY PRIEST DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3905
Practice Address - Country:US
Practice Address - Phone:615-584-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health