Healthcare Provider Details

I. General information

NPI: 1598354813
Provider Name (Legal Business Name): MAPLE STREET COUNSELING CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 WARD LN
COTTAGE GROVE TN
38224-5245
US

IV. Provider business mailing address

230 TYSON AVE STE B PMB 199
PARIS TN
38242-5823
US

V. Phone/Fax

Practice location:
  • Phone: 270-610-0704
  • Fax: 270-220-7664
Mailing address:
  • Phone: 270-610-0704
  • Fax: 270-220-7664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LISA MARIE GABEL
Title or Position: OWNER
Credential: LPCC-S
Phone: 270-610-0704