Provider Demographics
NPI:1396269676
Name:DEVINE, JEFFREY LANE (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LANE
Last Name:DEVINE
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 HAZELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-3922
Mailing Address - Country:US
Mailing Address - Phone:270-584-3565
Mailing Address - Fax:
Practice Address - Street 1:1324 HAZELWOOD DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3922
Practice Address - Country:US
Practice Address - Phone:270-584-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104179101YP2500X
TN3528101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional