Healthcare Provider Details

I. General information

NPI: 1386804862
Provider Name (Legal Business Name): JESSICA SAMFORD CONLEY LPC - MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 STRINGTOWN RD
LEXINGTON TN
38351-4836
US

IV. Provider business mailing address

PO BOX 463
LEXINGTON TN
38351-0463
US

V. Phone/Fax

Practice location:
  • Phone: 615-348-5707
  • Fax:
Mailing address:
  • Phone: 615-415-2212
  • Fax: 866-867-4298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2173
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: