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General NPI Number Information
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NPI Number | 1558404178
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Entity Type | Individual
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Provider Name | TRACIA HUGHES JUNGKURTH PHD, LPC, LMHC
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Gender | Female
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 01/06/2016
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Provider Practice Location Address
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Address Line | 313B 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 | 615-636-7414
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Fax | 866-799-4512
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Provider Business Mailing Address
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Address Line | PO BOX 555
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City | MOUNT JULIET
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State | TN
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Zip | 37121-0555
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Country | US
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Telephone | 615-636-7414
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Fax | 866-799-4512
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1827
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH9523
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License Number State | FL
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