Provider Demographics
NPI:1629678909
Name:FUSON, JARED S (LPCMHSP)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:S
Last Name:FUSON
Suffix:
Gender:M
Credentials:LPCMHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 JOHN SEVIER AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-1402
Mailing Address - Country:US
Mailing Address - Phone:921-284-8152
Mailing Address - Fax:
Practice Address - Street 1:104 JOHN SEVIER AVE
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1402
Practice Address - Country:US
Practice Address - Phone:921-284-8152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000004216101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional