Healthcare Provider Details

I. General information

NPI: 1982489720
Provider Name (Legal Business Name): JARED DUKE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 MARLIN RD
CHATTANOOGA TN
37411-5644
US

IV. Provider business mailing address

5721 MARLIN RD STE 3800
CHATTANOOGA TN
37411-5651
US

V. Phone/Fax

Practice location:
  • Phone: 423-521-5678
  • Fax:
Mailing address:
  • Phone: 423-521-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: