Healthcare Provider Details

I. General information

NPI: 1982905782
Provider Name (Legal Business Name): JACOB N PARSONS-WELLS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E BROADWAY AVE STE 200
MARYVILLE TN
37804-5709
US

IV. Provider business mailing address

200 E BROADWAY AVE STE 200
MARYVILLE TN
37804-5709
US

V. Phone/Fax

Practice location:
  • Phone: 865-238-5358
  • Fax:
Mailing address:
  • Phone: 865-238-5358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1862
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: