Provider Demographics
NPI:1124759675
Name:PARRISH, JANET JACKSON (LADAC II, NCAC II)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:JACKSON
Last Name:PARRISH
Suffix:
Gender:F
Credentials:LADAC II, NCAC II
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:RENEE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1810 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5531
Mailing Address - Country:US
Mailing Address - Phone:615-243-0569
Mailing Address - Fax:
Practice Address - Street 1:1139 NW BROAD ST STE 102
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2390
Practice Address - Country:US
Practice Address - Phone:615-243-0569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1128101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1128OtherTENNESSEE DEPARTMENT OF HEALTH