1538351903 NPI number — KINGDOM MINISTRIES COUNSELING CENTER

Table of content: (NPI 1538351903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538351903 NPI number — KINGDOM MINISTRIES COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINGDOM MINISTRIES COUNSELING CENTER
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:
1538351903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8245 CORDOVA RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CORDOVA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38016-2086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-507-4519
Provider Business Mailing Address Fax Number:
901-881-6911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8245 CORDOVA RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CORDOVA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38016-2086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-507-4519
Provider Business Practice Location Address Fax Number:
901-881-6911
Provider Enumeration Date:
08/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUINN
Authorized Official First Name:
ADDIE
Authorized Official Middle Name:
HALL
Authorized Official Title or Position:
LICENSED CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
901-507-4519

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW0000003139 , 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: 4136024 . This is a "BCBSTN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 600014 . This is a "MAGELLAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4147539 . This is a "BCBSTN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 599764 . This is a "MAGELLAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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