Provider Demographics
NPI:1508206590
Name:WOLF, JILLIAN (PHD - HSP)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:PHD - HSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 NISSAN DRIVE
Mailing Address - Street 2:STE. 303
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-4360
Mailing Address - Country:US
Mailing Address - Phone:615-972-6644
Mailing Address - Fax:615-624-9114
Practice Address - Street 1:433 NISSAN DRIVE
Practice Address - Street 2:STE. 303
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4360
Practice Address - Country:US
Practice Address - Phone:615-972-6644
Practice Address - Fax:615-624-9114
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3103103T00000X
TNTN3103103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist