Provider Demographics
NPI:1982228854
Name:TANNEHILL, JENNIFER COOLEY (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:COOLEY
Last Name:TANNEHILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 MILLBRANCH RD STE 20
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1673
Mailing Address - Country:US
Mailing Address - Phone:601-255-5264
Mailing Address - Fax:866-625-0559
Practice Address - Street 1:32 MILLBRANCH RD STE 20
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1673
Practice Address - Country:US
Practice Address - Phone:601-255-5264
Practice Address - Fax:866-625-0559
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS265845103TS0200X
MS621141103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool