Provider Demographics
NPI:1174159354
Name:SEYMOUR, JENNIFER PAIGE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PAIGE
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 NEAL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-0917
Mailing Address - Country:US
Mailing Address - Phone:931-528-8593
Mailing Address - Fax:931-528-8214
Practice Address - Street 1:1101 NEAL ST STE 101
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0917
Practice Address - Country:US
Practice Address - Phone:931-528-8593
Practice Address - Fax:931-528-8214
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000004943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health