Basic Information
Provider Information
NPI: 1003140450
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROBINSON
FirstName: JEANNE
MiddleName: S
NamePrefix: MRS.
NameSuffix:  
Credential: MS, LPC,MHSP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1724 COUNTRY CLUB DR
Address2:  
City: TULLAHOMA
State: TN
PostalCode: 373884825
CountryCode: US
TelephoneNumber: 4233123364
FaxNumber:  
Practice Location
Address1: 11133 TULLAHOMA HWY
Address2:  
City: TULLAHOMA
State: TN
PostalCode: 373886016
CountryCode: US
TelephoneNumber: 9314549994
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/01/2009
LastUpdateDate: 06/15/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X2541TNY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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