Healthcare Provider Details

I. General information

NPI: 1023146768
Provider Name (Legal Business Name): TIMOTHY CORDELL SEWELL LPCMHSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 GALLATIN PIKE
NASHVILLE TN
37216-2609
US

IV. Provider business mailing address

3831 GALLATIN PIKE
NASHVILLE TN
37216-2609
US

V. Phone/Fax

Practice location:
  • Phone: 615-460-4260
  • Fax: 615-460-4263
Mailing address:
  • Phone: 615-460-4260
  • Fax: 615-460-4263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC0000000844
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: