Provider Demographics
NPI:1396272662
Name:JERGENSEN, CLAIRE COLEMAN (LPC-MHSP, NCC)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:COLEMAN
Last Name:JERGENSEN
Suffix:
Gender:F
Credentials:LPC-MHSP, NCC
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:ELIZABETH
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:613 HUNTINGTON CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1113 MURFREESBORO RD STE 202
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-1318
Practice Address - Country:US
Practice Address - Phone:615-790-0567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YP2500X
TN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional