Provider Demographics
NPI:1861166118
Name:OMER, JESSIE CARROLL (M ED, NCC)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:CARROLL
Last Name:OMER
Suffix:
Gender:F
Credentials:M ED, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CHURCH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2285
Mailing Address - Country:US
Mailing Address - Phone:615-727-2526
Mailing Address - Fax:
Practice Address - Street 1:1900 CHURCH ST STE 300
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2285
Practice Address - Country:US
Practice Address - Phone:615-727-2526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty