Healthcare Provider Details

I. General information

NPI: 1447532205
Provider Name (Legal Business Name): TT & S FAMILY FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 PLUS PARK BLVD
NASHVILLE TN
37217-1098
US

IV. Provider business mailing address

PO BOX 132
OLD HICKORY TN
37138-0132
US

V. Phone/Fax

Practice location:
  • Phone: 615-915-4074
  • Fax: 615-942-6342
Mailing address:
  • Phone: 615-915-4074
  • Fax: 615-942-6392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2111
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2111
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3847
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2111
License Number StateTN

VIII. Authorized Official

Name: MS. THELMA DEES-JOHNSON
Title or Position: LPC-MHSP
Credential:
Phone: 61591504074