Individual
MRS. JENNIFER EALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
696 JACKSON AVE, MEMPHIS, TN 38105-2006
(901) 260-9124
Mailing address
449 ERICSON ST, SOUTHAVEN, MS 38672-7071
(763) 242-1095
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/05/2018
Last updated
04/05/2018
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