Healthcare Provider Details

I. General information

NPI: 1144148677
Provider Name (Legal Business Name): JALEESA COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 CHEATHAM ST
SPRINGFIELD TN
37172-2828
US

IV. Provider business mailing address

713 CHEATHAM ST
SPRINGFIELD TN
37172-2828
US

V. Phone/Fax

Practice location:
  • Phone: 615-463-6202
  • Fax:
Mailing address:
  • Phone: 615-463-6200
  • Fax: 615-463-6202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8746
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: