Basic Information
| Provider Information | |||||||||
| NPI: | 1437672821 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUGULEY | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | JENSEN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JENSEN | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
| OtherMiddleName: | SHAYLEEN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6350 W ANDREW JOHNSON HWY DEPT 100 | ||||||||
| Address2: | |||||||||
| City: | TALBOTT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378778605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003553565 | ||||||||
| FaxNumber: | 4237142355 | ||||||||
| Practice Location | |||||||||
| Address1: | 1107 N CHARLES G SEIVERS BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377163944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659346150 | ||||||||
| FaxNumber: | 8653420150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2017 | ||||||||
| LastUpdateDate: | 09/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | 11456 | TN | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.