Provider Demographics
NPI:1881428308
Name:JACKSON, TIMOTHY L JR (LMFT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:L
Last Name:JACKSON
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4176 LONGFELLOW DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-1182
Mailing Address - Country:US
Mailing Address - Phone:615-200-8734
Mailing Address - Fax:
Practice Address - Street 1:5001 GALLATIN PIKE STE 1
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37216-1322
Practice Address - Country:US
Practice Address - Phone:615-200-8734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2046106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist