Healthcare Provider Details

I. General information

NPI: 1548644735
Provider Name (Legal Business Name): INFINITE POSSIBILITIES COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 WALNUT GROVE RD
SPARTA TN
38583-5365
US

IV. Provider business mailing address

3380 WALNUT GROVE RD
SPARTA TN
38583-5365
US

V. Phone/Fax

Practice location:
  • Phone: 931-372-7117
  • Fax: 931-372-7119
Mailing address:
  • Phone: 931-372-7117
  • Fax: 931-372-7119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SUSAN A. FREITAG
Title or Position: CHIEF MANAGER
Credential: LPC-MHSP
Phone: 931-372-7117