Provider Demographics
NPI:1740246057
Name:DACHS, JIMMY D (LPC-MHSP)
Entity type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:D
Last Name:DACHS
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 1:1186 HWY 45 BYPASS STE D
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3256
Mailing Address - Country:US
Mailing Address - Phone:731-215-0502
Mailing Address - Fax:731-345-4086
Practice Address - Street 1:1186 HWY 45 BYPASS STE D
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3256
Practice Address - Country:US
Practice Address - Phone:731-215-0502
Practice Address - Fax:731-345-4086
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002012996101YP2500X
TN5954101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ074026Medicaid