Provider Demographics
NPI:1790961852
Name:NORTHROP, JEREMY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:M
Last Name:NORTHROP
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 1:170 FRANK LATHAM RD
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:TN
Mailing Address - Zip Code:38366-9632
Mailing Address - Country:US
Mailing Address - Phone:731-989-7335
Mailing Address - Fax:731-989-7288
Practice Address - Street 1:170 FRANK LATHAM RD
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:TN
Practice Address - Zip Code:38366-9632
Practice Address - Country:US
Practice Address - Phone:731-989-7335
Practice Address - Fax:731-989-7288
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN3866101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health