1932336732 NPI number — ODYSSEY COUNSELING

Table of content: (NPI 1932336732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932336732 NPI number — ODYSSEY COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ODYSSEY COUNSELING
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:
1932336732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
638 W IRIS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37204-3191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-975-7084
Provider Business Mailing Address Fax Number:
615-292-4459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
638 W IRIS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37204-3191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-975-7084
Provider Business Practice Location Address Fax Number:
615-292-4459
Provider Enumeration Date:
06/18/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
615-975-7084

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  3120 , 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)

  • Identifier: 114956876 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 187217000 . This is a "MAGELLAN BEHAVIORAL HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3695729 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 976020 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 11509576 . This is a "CAQH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".