Provider Demographics
NPI:1477733905
Name:GODLOVE, JENNIFER A (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:GODLOVE
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 STAGE RD STE 42-275
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-8374
Mailing Address - Country:US
Mailing Address - Phone:901-654-6882
Mailing Address - Fax:
Practice Address - Street 1:6025 STAGE RD STE 42-275
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-8374
Practice Address - Country:US
Practice Address - Phone:901-654-6882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3627103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical