Individual
JESSE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC/MHSP
Contact information
Practice address
4 REBEL CV, JACKSON, TN 38301-7707
(731) 234-2165
Mailing address
4 REBEL CV, JACKSON, TN 38301-7707
(731) 234-2165
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0044
MS
101YP2500X
Professional Counselor
Primary
4913
TN
Other
Enumeration date
04/22/2010
Last updated
12/04/2025
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