Provider Demographics
NPI:1649618521
Name:HAMM, JESSICA SMITH (LPC, MHSP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SMITH
Last Name:HAMM
Suffix:
Gender:F
Credentials:LPC, MHSP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC,MHSP
Mailing Address - Street 1:1207 WASHINGTON ST W
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2855
Mailing Address - Country:US
Mailing Address - Phone:615-504-1926
Mailing Address - Fax:
Practice Address - Street 1:709 DAVIDSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3607
Practice Address - Country:US
Practice Address - Phone:615-504-1926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000002959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health