Provider Demographics
NPI:1013733005
Name:JARVIS, IAN JACOB (MFT-I)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:JACOB
Last Name:JARVIS
Suffix:
Gender:M
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GEORGIA AVE STE 1E
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-1407
Mailing Address - Country:US
Mailing Address - Phone:423-402-0130
Mailing Address - Fax:
Practice Address - Street 1:600 GEORGIA AVE STE 1E
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-1407
Practice Address - Country:US
Practice Address - Phone:423-402-0130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist