1952489940 NPI number — GOOD SHEPHERD COUNSELING SERVICE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952489940 NPI number — GOOD SHEPHERD COUNSELING SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD SHEPHERD COUNSELING SERVICE 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:
1952489940
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:
1139 SOUTH WRIGHTS LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLATIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-452-0030
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 STEAM PLANT RD
Provider Second Line Business Practice Location Address:
SUITE 440
Provider Business Practice Location Address City Name:
GALLATIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-451-7700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIEL
Authorized Official First Name:
GLORIA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT OF CORPORATION
Authorized Official Telephone Number:
615-451-7700

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  PE0000001204 , 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)





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