Healthcare Provider Details

I. General information

NPI: 1780326546
Provider Name (Legal Business Name): GABRIEL MAX STARNER TLMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 21ST AVE S STE 410
NASHVILLE TN
37212-4350
US

IV. Provider business mailing address

2021 21ST AVE S STE 410
NASHVILLE TN
37212-4350
US

V. Phone/Fax

Practice location:
  • Phone: 615-492-6700
  • Fax:
Mailing address:
  • Phone: 615-492-6700
  • Fax: 615-492-6710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1875
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: