Healthcare Provider Details

I. General information

NPI: 1467087635
Provider Name (Legal Business Name): TIMOTHY ANDREW CLOUSE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HOSPITAL DR
MADISON TN
37115-5031
US

IV. Provider business mailing address

300 20TH AVE N STE 403
NASHVILLE TN
37203-5180
US

V. Phone/Fax

Practice location:
  • Phone: 615-769-5253
  • Fax: 615-769-5945
Mailing address:
  • Phone: 615-284-4029
  • Fax: 615-284-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7145
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: