MEDICARE: MS. JORJA DEANN CALICO M.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	1997	OK

General Provider Information

NPI Number	:	1144553389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JORJA DEANN CALICO M.ED.

Provider Business Mailing Address
First Line	:	3323 FALLS CREEK DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37214-3416
Country	:	US
Telephone Number	:	615-391-5178
Fax Number	:	615-391-5178

Provider Business Practice Location Address
First Line	:	3323 FALLS CREEK DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37214-3416
Country	:	US
Telephone Number	:	615-391-5178
Fax Number	:	615-391-5178

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2009
Last Update Date	:	09/04/2009

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