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NPI Code Detail

MEDICARE: JESSIE BETH GLADDEN LPC-T

MEDICARE: JESSIE BETH GLADDEN LPC-T
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
1101YM0800XMental Health CounselorTN

General Provider Information

NPI Number : 1639925118
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSIE BETH GLADDEN LPC-T
Provider Business Mailing Address
First Line : 210 25TH AVE N STE 1010
Second Line :
City : NASHVILLE
State : TN
Zip : 37203-1651
Country : US
Telephone Number : 615-283-0752
Fax Number :
Provider Business Practice Location Address
First Line : 210 25TH AVE N STE 1010
Second Line :
City : NASHVILLE
State : TN
Zip : 37203-1651
Country : US
Telephone Number : 615-283-0752
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2024
Last Update Date : 04/25/2024

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