Provider Demographics
NPI:1689747537
Name:HASTY, JO ANN (LCSW, ACSW, MSW)
Entity Type:Individual
Prefix:MS
First Name:JO ANN
Middle Name:
Last Name:HASTY
Suffix:
Gender:F
Credentials:LCSW, ACSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6503
Mailing Address - Country:US
Mailing Address - Phone:865-482-1337
Mailing Address - Fax:865-482-1360
Practice Address - Street 1:240 W TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6503
Practice Address - Country:US
Practice Address - Phone:865-482-1337
Practice Address - Fax:865-482-1360
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3695010Medicaid
TN3695010Medicare ID - Type Unspecified
TN3695010Medicaid