Healthcare Provider Details

I. General information

NPI: 1609109263
Provider Name (Legal Business Name): JENNIFER CLARK BURTON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 CHURCH ST SUITE 800
NASHVILLE TN
37203-2021
US

IV. Provider business mailing address

9019 OVERLOOK BLVD STE C1A
BRENTWOOD TN
37027-5351
US

V. Phone/Fax

Practice location:
  • Phone: 615-385-4090
  • Fax:
Mailing address:
  • Phone: 615-385-4090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberP0000002358
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: