Provider Demographics
NPI:1669163549
Name:GRASTY, JORDAN ASHLEY LOVETERE (LPC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ASHLEY LOVETERE
Last Name:GRASTY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:ASHLEY
Other - Last Name:LOVETERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1719 W LAKEVIEW DR APT 5
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4345
Mailing Address - Country:US
Mailing Address - Phone:865-851-1173
Mailing Address - Fax:
Practice Address - Street 1:4132 BRISTOL HWY STE 5
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-3162
Practice Address - Country:US
Practice Address - Phone:423-218-2131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6540101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty