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General NPI Number Information
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NPI Number | 1336645670
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Entity Type | Organization
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Legal Business Name | PRENTISS COUNSELING AND CONSULTING PLLC
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 5320 HICKORY HOLLOW PKWY
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City | ANTIOCH
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State | TN
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Zip | 37013-3128
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Country | US
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Telephone | 615-669-5605
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Fax |
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Provider Business Mailing Address
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Address Line | 1091 SECRETARIAT DR
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City | MOUNT JULIET
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State | TN
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Zip | 37122-3568
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Country | US
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Telephone | 615-669-5605
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JARED PRENTISS
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Credential | LPC-MHSP
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Telephone | 615-669-5605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2904
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License Number State | TN
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