Provider Demographics
NPI:1558812495
Name:SHAPIRO, JEREMY (LPC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 FRANKLIN PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220-1121
Mailing Address - Country:US
Mailing Address - Phone:615-298-9595
Mailing Address - Fax:
Practice Address - Street 1:842 TYNE BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1505
Practice Address - Country:US
Practice Address - Phone:615-298-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-15
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional