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General NPI Number Information
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NPI Number | 1174180111
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Entity Type | Individual
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Provider Name | JARROD LYNN JUSTICE MAMFT
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Gender | Male
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Dates
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Enumeration Date | 05/24/2019
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 110 PERIMETER PARK RD STE A
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City | KNOXVILLE
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State | TN
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Zip | 37922-2200
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Country | US
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Telephone | 865-409-5001
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Fax | 865-415-3311
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Provider Business Mailing Address
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Address Line | 110 PERIMETER PARK RD STE A
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City | KNOXVILLE
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State | TN
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Zip | 37922-2200
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Country | US
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Telephone | 865-409-5001
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Fax | 865-415-3311
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1674
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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