Provider Demographics
NPI:1376878942
Name:SUBLETT, JEREMY ALAN (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:ALAN
Last Name:SUBLETT
Suffix:
Gender:M
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 1:1633 W MAIN ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3423
Mailing Address - Country:US
Mailing Address - Phone:615-547-4994
Mailing Address - Fax:615-547-4995
Practice Address - Street 1:1633 W MAIN ST
Practice Address - Street 2:SUITE 901
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3423
Practice Address - Country:US
Practice Address - Phone:615-547-4994
Practice Address - Fax:615-547-4995
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000002521101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1516554Medicaid