Provider Demographics
NPI:1902579105
Name:LOUVERTURE, JESSICA CONKLIN (MA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:CONKLIN
Last Name:LOUVERTURE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 BROOKMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1395
Mailing Address - Country:US
Mailing Address - Phone:615-348-7653
Mailing Address - Fax:
Practice Address - Street 1:1804 BROOKMEADOW LN
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1395
Practice Address - Country:US
Practice Address - Phone:615-348-7653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2213101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health