Provider Demographics
NPI:1922560606
Name:TIETZ, JILL HUSE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:HUSE
Last Name:TIETZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 HARDING PIKE STE B
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2838
Mailing Address - Country:US
Mailing Address - Phone:615-761-6778
Mailing Address - Fax:
Practice Address - Street 1:5407 HARDING PIKE STE B
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2838
Practice Address - Country:US
Practice Address - Phone:615-761-6778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLMT0000001300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist