Provider Demographics
NPI:1891469409
Name:CRADY, JEREMY REID
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:REID
Last Name:CRADY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 PLANTATION CT
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-3326
Mailing Address - Country:US
Mailing Address - Phone:615-479-0948
Mailing Address - Fax:
Practice Address - Street 1:7015 CONCORD RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-6606
Practice Address - Country:US
Practice Address - Phone:615-479-0948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1783101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health