Provider Demographics
NPI:1033850904
Name:MCGLAMERY, JACOB DOUGLAS (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:DOUGLAS
Last Name:MCGLAMERY
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-4835
Mailing Address - Country:US
Mailing Address - Phone:423-963-0052
Mailing Address - Fax:
Practice Address - Street 1:211 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-1325
Practice Address - Country:US
Practice Address - Phone:423-727-2640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty