Individual
JASON LEE MAYNARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
TEMP-LPC/MHSP
Contact information
Practice address
441 E BROAD ST STE G, COOKEVILLE, TN 38501-3390
(931) 952-6869
Mailing address
7314 SPARTA HWY, SPARTA, TN 38583-4186
(931) 952-6869
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7880
TN
Other
Enumeration date
09/24/2025
Last updated
09/24/2025
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