Healthcare Provider Details

I. General information

NPI: 1346493574
Provider Name (Legal Business Name): MIDDLE TENNESSEE COUNSELING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 PARK AVENUE STALLINGS BUILDING
LEBANON TN
37087-3630
US

IV. Provider business mailing address

435 PARK AVENUE STALLINGS BUILDING
LEBANON TN
37087-3630
US

V. Phone/Fax

Practice location:
  • Phone: 615-453-7530
  • Fax: 615-453-7531
Mailing address:
  • Phone: 615-453-7530
  • Fax: 615-453-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1496
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1725
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1427
License Number StateTN

VIII. Authorized Official

Name: JASON T LINK
Title or Position: MANAGER
Credential: LPC
Phone: 615-453-7530