Provider Demographics
NPI:1154184364
Name:LUCY, JACOB D (NCC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:D
Last Name:LUCY
Suffix:
Gender:M
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1502
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37077-1502
Mailing Address - Country:US
Mailing Address - Phone:615-275-8061
Mailing Address - Fax:
Practice Address - Street 1:1201 LIBERTY PIKE STE 205
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5646
Practice Address - Country:US
Practice Address - Phone:615-637-1532
Practice Address - Fax:888-531-4168
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health