1760684799 NPI number — COUNSELING SERVICES OF MIDDLE TN, LLC

Table of content: (NPI 1760684799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760684799 NPI number — COUNSELING SERVICES OF MIDDLE TN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNSELING SERVICES OF MIDDLE TN, LLC
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:
1760684799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 292434
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:
37229-2434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-418-0538
Provider Business Mailing Address Fax Number:
615-859-4990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 NORTH MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOODLETTSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-418-0538
Provider Business Practice Location Address Fax Number:
615-859-4990
Provider Enumeration Date:
06/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PADULA
Authorized Official First Name:
KIM
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
615-418-0538

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  3352 , 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)





Copyright © 2007-2025 www.npivalidator.com