Healthcare Provider Details

I. General information

NPI: 1609198217
Provider Name (Legal Business Name): CHAD M HUGHES LPC MHSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 PARK AVE
LEBANON TN
37087-3664
US

IV. Provider business mailing address

440 PARK AVE
LEBANON TN
37087
US

V. Phone/Fax

Practice location:
  • Phone: 615-449-9611
  • Fax: 615-453-7051
Mailing address:
  • Phone: 615-516-1086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 2505
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: