=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083269740
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THURMAN E. WEBB JR. ED.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2019
-----------------------------------------------------
Last Update Date | 08/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1712 EXECUTIVE WAY
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37207-1660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-479-7932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1712 EXECUTIVE WAY
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37207-1660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-479-7932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC010605
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------