MEDICARE: SHIRLEY MARKS LADAC, LMFT, MAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LDC0000000573	TN
2	106H00000X	Marriage & Family Therapist	LMT0000001090	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215477864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY MARKS LADAC, LMFT, MAC

Provider Business Mailing Address
First Line	:	2303 BARCLAY DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-1501
Country	:	US
Telephone Number	:	615-262-3497
Fax Number	:

Provider Business Practice Location Address
First Line	:	431 NISSAN DR STE 202
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-4365
Country	:	US
Telephone Number	:	615-462-7392
Fax Number	:	615-267-0020

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

Provider Enumeration Date	:	03/01/2017
Last Update Date	:	08/17/2021

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