Healthcare Provider Details

I. General information

NPI: 1811956816
Provider Name (Legal Business Name): THEDA DIANE BELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S TATUM ST
WOODBURY TN
37190-1138
US

IV. Provider business mailing address

PO BOX 434 105 SOUTH TATUM STREET
WOODBURY TN
37190-0434
US

V. Phone/Fax

Practice location:
  • Phone: 615-563-8501
  • Fax: 615-536-8501
Mailing address:
  • Phone: 615-563-8501
  • Fax: 615-536-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW0000003650
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: