Provider Demographics
NPI:1598402869
Name:PRESCOTT, JESSIE SCHYLAR
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:SCHYLAR
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:SCHYLAR
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3041 VERONA CANEY RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-6548
Mailing Address - Country:US
Mailing Address - Phone:931-652-2953
Mailing Address - Fax:
Practice Address - Street 1:2122 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4430
Practice Address - Country:US
Practice Address - Phone:931-490-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor