Healthcare Provider Details

I. General information

NPI: 1326558263
Provider Name (Legal Business Name): CASEY JOLLY LSCW-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2723 NEW SALEM HWY
MURFREESBORO TN
37128-5253
US

IV. Provider business mailing address

300 20TH AVE N STE 403
NASHVILLE TN
37203-5180
US

V. Phone/Fax

Practice location:
  • Phone: 615-396-6850
  • Fax: 615-396-6855
Mailing address:
  • Phone: 615-284-7261
  • Fax: 615-284-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7916
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: