MEDICARE: TRIAD COUNSELING AND WELLNESS CORP

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1851863542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIAD COUNSELING AND WELLNESS CORP

Provider Business Mailing Address
First Line	:	1400 N MOUNT JULIET RD STE 204
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-1509
Country	:	US
Telephone Number	:	615-481-2495
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 N MOUNT JULIET RD STE 204
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-1509
Country	:	US
Telephone Number	:	615-481-2495
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ANA LENNIR ZUNIGA
Credential	:	LMFT
Telephone Number	:	615-481-2495

Provider Enumeration Date	:	12/19/2018
Last Update Date	:	12/19/2018

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