Healthcare Provider Details

I. General information

NPI: 1952865743
Provider Name (Legal Business Name): JENNIFER MAYNARD MMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 21ST AVE S STE 304
NASHVILLE TN
37212-4929
US

IV. Provider business mailing address

1607 PENNINGTON DR
MURFREESBORO TN
37129-5880
US

V. Phone/Fax

Practice location:
  • Phone: 615-905-6371
  • Fax:
Mailing address:
  • Phone: 615-217-2569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1569
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: