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General NPI Number Information
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NPI Number | 1619628096
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Entity Type | Individual
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Provider Name | JEFFREY JAY WALLER JR. LPC-MHSP
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Gender | Male
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Dates
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Enumeration Date | 01/17/2022
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Last Update Date | 01/17/2022
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Provider Practice Location Address
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Address Line | 9025 OVERLOOK BLVD STE 200
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City | BRENTWOOD
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State | TN
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Zip | 37027-2710
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Country | US
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Telephone | 864-642-5004
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Fax |
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Provider Business Mailing Address
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Address Line | 500 ROLLING MILL HILL RD APT 306
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City | NASHVILLE
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State | TN
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Zip | 37210-2525
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Country | US
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Telephone | 864-642-5004
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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