Provider Demographics
NPI:1760868970
Name:KIERNAN, JACQUELYN ELIZA (LPC)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:ELIZA
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E MOUNTCASTLE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2509
Mailing Address - Country:US
Mailing Address - Phone:423-283-4958
Mailing Address - Fax:423-283-7135
Practice Address - Street 1:214 E MOUNTCASTLE DR STE 1
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2509
Practice Address - Country:US
Practice Address - Phone:423-283-4958
Practice Address - Fax:423-283-7135
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4125101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional