Healthcare Provider Details

I. General information

NPI: 1457854846
Provider Name (Legal Business Name): GWENDOLYN CANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 BRANDIES CIR STE A
MURFREESBORO TN
37128-7751
US

IV. Provider business mailing address

PO BOX 2146
ANTIOCH TN
37011-2146
US

V. Phone/Fax

Practice location:
  • Phone: 931-492-9827
  • Fax:
Mailing address:
  • Phone: 931-492-9827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5212
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: