Provider Demographics
NPI:1053909549
Name:DREHER, JACK JUSTIN (LPC-MHSP (TEMP), NCC)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:JUSTIN
Last Name:DREHER
Suffix:
Gender:M
Credentials:LPC-MHSP (TEMP), NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 RIVERSIDE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-5448
Mailing Address - Country:US
Mailing Address - Phone:615-392-1821
Mailing Address - Fax:
Practice Address - Street 1:357 RIVERSIDE DR STE 220
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-5448
Practice Address - Country:US
Practice Address - Phone:615-392-1821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional