Provider Demographics
NPI:1770677791
Name:LANGLEY, JAMIE LYNN (LCSW, RPT-S)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:LCSW, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 POTOMAC PL STE 401
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5657
Mailing Address - Country:US
Mailing Address - Phone:615-267-0779
Mailing Address - Fax:615-625-3371
Practice Address - Street 1:617 POTOMAC PL STE 401
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5657
Practice Address - Country:US
Practice Address - Phone:615-267-0779
Practice Address - Fax:615-625-3371
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3696718Medicaid
3696718OtherMEDICARE