Healthcare Provider Details

I. General information

NPI: 1215468467
Provider Name (Legal Business Name): HENDRICK COUNSELING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
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: 615-449-9611
  • Fax: 615-453-7051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberAPN0000012314
License Number StateTN

VIII. Authorized Official

Name: MRS. KIMBERLEY HENDRICK
Title or Position: OWNER
Credential: LCSW
Phone: 615-449-9611