Provider Demographics
NPI:1407336381
Name:GAINES OSBORN, JESSICA ANN (LPC-MHSP, NCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:GAINES OSBORN
Suffix:
Gender:F
Credentials:LPC-MHSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6681 SUNRISE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-3112
Mailing Address - Country:US
Mailing Address - Phone:901-634-0302
Mailing Address - Fax:
Practice Address - Street 1:8820 TRINITY RD STE 202
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-2735
Practice Address - Country:US
Practice Address - Phone:901-756-8398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4356101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional