MEDICARE: VICKI L MEAD LPC/MHSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	1881	TN

General Provider Information

NPI Number	:	1053715151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI L MEAD LPC/MHSP

Provider Business Mailing Address
First Line	:	2702 FAIRFAX AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-3309
Country	:	US
Telephone Number	:	615-594-2514
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 WARFIELD DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-3424
Country	:	US
Telephone Number	:	615-594-2514
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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