Healthcare Provider Details

I. General information

NPI: 1114139243
Provider Name (Legal Business Name): THERAPEUTIC INTERVENTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 W JACKSON ST
COOKEVILLE TN
38501-5940
US

IV. Provider business mailing address

831 W JACKSON ST
COOKEVILLE TN
38501-5940
US

V. Phone/Fax

Practice location:
  • Phone: 931-520-4418
  • Fax: 931-526-8432
Mailing address:
  • Phone: 931-520-4418
  • Fax: 931-526-8432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC790
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberP377
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberP377
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberP377
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberP377
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberP377
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberP377
License Number StateTN

VIII. Authorized Official

Name: MS. CECILIA L CAMPBELL
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 931-520-4418