Provider Demographics
NPI:1780432716
Name:OUSLEY, JACOB S
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:S
Last Name:OUSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4907 DARLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5105
Mailing Address - Country:US
Mailing Address - Phone:615-973-4305
Mailing Address - Fax:
Practice Address - Street 1:2416 21ST AVE S STE 203
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-5312
Practice Address - Country:US
Practice Address - Phone:615-973-4305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist