Provider Demographics
NPI:1356474639
Name:HERMAN, JEFFERY SCOTT (LPC, SPE, MA)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:SCOTT
Last Name:HERMAN
Suffix:
Gender:M
Credentials:LPC, SPE, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-5940
Mailing Address - Country:US
Mailing Address - Phone:931-520-4418
Mailing Address - Fax:866-662-9843
Practice Address - Street 1:831 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-5940
Practice Address - Country:US
Practice Address - Phone:931-520-4418
Practice Address - Fax:866-662-9843
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC790101YP2500X
TNPE1585103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441689Medicaid