Provider Demographics
NPI:1699344341
Name:MATHENY, JAKAY LAMARR (LCSW)
Entity type:Individual
Prefix:
First Name:JAKAY
Middle Name:LAMARR
Last Name:MATHENY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 TINY TOWN RD # 297
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-7202
Mailing Address - Country:US
Mailing Address - Phone:931-251-9722
Mailing Address - Fax:
Practice Address - Street 1:1477 TINY TOWN RD # 297
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-7202
Practice Address - Country:US
Practice Address - Phone:931-251-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000012424104100000X
TN81031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker