Provider Demographics
NPI:1902451750
Name:JEANES, CAYCE CAROL (LPC-MHSP, TEMPORARY)
Entity type:Individual
Prefix:
First Name:CAYCE
Middle Name:CAROL
Last Name:JEANES
Suffix:
Gender:F
Credentials:LPC-MHSP, TEMPORARY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8652 WINE LEAF CV
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-4443
Mailing Address - Country:US
Mailing Address - Phone:901-486-2527
Mailing Address - Fax:
Practice Address - Street 1:240 MADISON AVE STE 602
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2770
Practice Address - Country:US
Practice Address - Phone:901-860-4218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional