Basic Information
Provider Information
NPI: 1346470903
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCGHEE
FirstName: JENNIFER
MiddleName: SUZANNE
NamePrefix:  
NameSuffix:  
Credential: BA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HILL
OtherFirstName: JENNIFER
OtherMiddleName: SUZANNE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: BA
OtherLastNameType: 1
Mailing Information
Address1: 201 W SPRINGDALE AVE
Address2:  
City: KNOXVILLE
State: TN
PostalCode: 379175158
CountryCode: US
TelephoneNumber: 8653299173
FaxNumber:  
Practice Location
Address1: 201 W SPRINGDALE AVE
Address2:  
City: KNOXVILLE
State: TN
PostalCode: 379175158
CountryCode: US
TelephoneNumber: 8653299173
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/16/2009
LastUpdateDate: 01/17/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


Home