Provider Demographics
NPI:1326558263
Name:JOLLY, CASEY (LSCW-A)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:JOLLY
Suffix:
Gender:F
Credentials:LSCW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:615-284-7261
Mailing Address - Fax:615-284-7501
Practice Address - Street 1:2723 NEW SALEM HWY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-5253
Practice Address - Country:US
Practice Address - Phone:615-396-6850
Practice Address - Fax:615-396-6855
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN79161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical