Provider Demographics
NPI:1952865743
Name:MAYNARD, JENNIFER (MMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 PENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-5880
Mailing Address - Country:US
Mailing Address - Phone:615-217-2569
Mailing Address - Fax:
Practice Address - Street 1:2200 21ST AVE S STE 304
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4929
Practice Address - Country:US
Practice Address - Phone:615-905-6371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1569106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist