1366534802 NPI number — MS. LESLIE SHERRONE LOWER LCSW

Table of content: MS. LESLIE SHERRONE LOWER LCSW (NPI 1366534802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366534802 NPI number — MS. LESLIE SHERRONE LOWER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOWER
Provider First Name:
LESLIE
Provider Middle Name:
SHERRONE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRUTE
Provider Other First Name:
LEE
Provider Other Middle Name:
SHERRONE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1366534802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 37
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHRISTIANA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37037-0037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-603-9057
Provider Business Mailing Address Fax Number:
615-625-2976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
239 VETERANS PARKWAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37128-6439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-603-9057
Provider Business Practice Location Address Fax Number:
615-625-2976
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  3967 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 6008 , 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: Q006362 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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