Individual
JERENY S TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA MHA
Contact information
Practice address
7160 N MAYO TRL, PIKEVILLE, KY 41501-3151
(606) 657-9988
(606) 653-0691
Mailing address
7160 N MAYO TRL, PIKEVILLE, KY 41501-3151
(606) 657-9988
(606) 653-0691
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
KY
Other
Enumeration date
11/08/2006
Last updated
05/24/2023
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