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General NPI Number Information
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NPI Number | 1114259033
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Entity Type | Individual
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Provider Name | RAQUEL JACKSON SHUTZE LPC-MHSP
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Gender | Female
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Dates
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Enumeration Date | 02/02/2010
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 311 W DIVISION ST
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City | MOUNT JULIET
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State | TN
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Zip | 37122-3207
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Country | US
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Telephone | 601-297-3132
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Fax |
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Provider Business Mailing Address
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Address Line | 6001 OLD HICKORY BLVD
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City | HERMITAGE
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State | TN
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Zip | 37076
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Country | US
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Telephone | 601-297-3132
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2559
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License Number State | TN
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