Provider Demographics
NPI:1851627327
Name:MOORE, JAYNIE BRADLEY (NCC, LPC, MHSP)
Entity Type:Individual
Prefix:
First Name:JAYNIE
Middle Name:BRADLEY
Last Name:MOORE
Suffix:
Gender:F
Credentials:NCC, LPC, MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 MEADOW CHASE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4748
Mailing Address - Country:US
Mailing Address - Phone:865-300-4541
Mailing Address - Fax:
Practice Address - Street 1:315 HOME AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-3970
Practice Address - Country:US
Practice Address - Phone:865-300-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2099101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health