Provider Demographics
NPI:1417732140
Name:MOBLEY, JENEVA
Entity Type:Individual
Prefix:
First Name:JENEVA
Middle Name:
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 OLD HIGHWAY 51 S STE F
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:TN
Mailing Address - Zip Code:38011-8025
Mailing Address - Country:US
Mailing Address - Phone:901-552-7397
Mailing Address - Fax:
Practice Address - Street 1:1880 OLD HIGHWAY 51 S STE F
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:TN
Practice Address - Zip Code:38011-8025
Practice Address - Country:US
Practice Address - Phone:901-552-7397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician