Basic Information
| Provider Information | |||||||||
| NPI: | 1740238146 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARRIS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 PRINCETON RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376012040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232820626 | ||||||||
| FaxNumber: | 4234392200 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 PRINCETON RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376012040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232820626 | ||||||||
| FaxNumber: | 4239000389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 944 | TN | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | LSW944 | TN | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.