1346493574 NPI number — MIDDLE TENNESSEE COUNSELING SERVICES, INC

Table of content: (NPI 1346493574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346493574 NPI number — MIDDLE TENNESSEE COUNSELING SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDDLE TENNESSEE COUNSELING SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346493574
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
435 PARK AVENUE
Provider Second Line Business Mailing Address:
STALLINGS BUILDING
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37087-3630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-453-7530
Provider Business Mailing Address Fax Number:
615-453-7531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
435 PARK AVENUE
Provider Second Line Business Practice Location Address:
STALLINGS BUILDING
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37087-3630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-453-7530
Provider Business Practice Location Address Fax Number:
615-453-7531
Provider Enumeration Date:
10/31/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LINK
Authorized Official First Name:
JASON
Authorized Official Middle Name:
T
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
615-453-7530

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  1496 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TA0400X , with the licence number: 1725 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 1427 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)