Provider Demographics
NPI:1760496624
Name:JESSEE, EDGAR HOWARD (PHD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:HOWARD
Last Name:JESSEE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N NORTHSHORE DR
Mailing Address - Street 2:SUITE S490
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4005
Mailing Address - Country:US
Mailing Address - Phone:865-584-0171
Mailing Address - Fax:865-584-0174
Practice Address - Street 1:1111 N NORTHSHORE DR
Practice Address - Street 2:SUITE S490
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4005
Practice Address - Country:US
Practice Address - Phone:865-584-0171
Practice Address - Fax:865-584-0174
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1058103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical