Healthcare Provider Details

I. General information

NPI: 1730458654
Provider Name (Legal Business Name): MIDDLE TENNESSEE RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 STEWARTS FERRY PIKE
NASHVILLE TN
37214-3325
US

IV. Provider business mailing address

275 STEWARTS FERRY PIKE
NASHVILLE TN
37214-3325
US

V. Phone/Fax

Practice location:
  • Phone: 615-231-5329
  • Fax: 615-884-4405
Mailing address:
  • Phone: 615-231-5329
  • Fax: 615-884-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD MICHAEL PRESLER
Title or Position: DIRECTOR
Credential:
Phone: 615-231-5329