Provider Demographics
NPI:1841884046
Name:MCKINNON, JEREMY BROOKS (LMSW)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:BROOKS
Last Name:MCKINNON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:JEREMY
Other - Middle Name:RYAN
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4813 CAPE HOPE PASS
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3669
Mailing Address - Country:US
Mailing Address - Phone:615-440-8716
Mailing Address - Fax:
Practice Address - Street 1:120 TWO MILE PIKE
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1832
Practice Address - Country:US
Practice Address - Phone:615-239-1404
Practice Address - Fax:615-900-2716
Is Sole Proprietor?:No
Enumeration Date:2021-02-27
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW12970104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker