Matthew Jae Donnelly

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2459 Issued in TN

Practice address

384 Carriage House Dr
Jackson, TN 38305-2268

Phone

(731) 868-7297

NPI assigned

Mar 27, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711497600000",
    "number": "1972354199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2442 MOORESVILLE PIKE",
            "city": "CULLEOKA",
            "state": "TN",
            "postal_code": "384512159",
            "telephone_number": "410-517-9906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "384 CARRIAGE HOUSE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052268",
            "telephone_number": "731-868-7297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "MATTHEW",
        "middle_name": "JAE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-27",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TN",
            "license": "2459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather R Dolan, A.P.R.N.
• Michael Sean Dolan, MD
• Heather Doles
• Sydney Donald, RBT
• Minh Dong
• Doris Doss, CRISIS CLINICIAN
• Jake Hunter Doster, D.C.
• Christopher A Douglas, DC
• Hope Douglas, FNP
• Kelvin L. Douglas, M.D.

• Mental Health Counselor in Jackson, TN
• Providers in Jackson, TN by specialty
• Mental Health Counselor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.