Healthcare Provider Details

I. General information

NPI: 1376613166
Provider Name (Legal Business Name): FRIEDA GAIL WHITT LICENSED PROF COUNSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 PARK AVENUE
LEBANON TN
37087
US

IV. Provider business mailing address

440 PARK AVENUE
LEBANON TN
37087
US

V. Phone/Fax

Practice location:
  • Phone: 615-449-9611
  • Fax: 615-453-7051
Mailing address:
  • Phone: 615-449-9611
  • Fax: 615-453-7051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1147
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: