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General NPI Number Information
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NPI Number | 1083439376
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Entity Type | Organization
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Legal Business Name | COALESCE SOCIAL SERVICES, INC.
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 879 W JACKSON ST STE B
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City | COOKEVILLE
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State | TN
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Zip | 38501-5901
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Country | US
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Telephone | 931-244-2804
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Fax |
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Provider Business Mailing Address
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Address Line | 879 W JACKSON ST STE B
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City | COOKEVILLE
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State | TN
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Zip | 38501-5901
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. PATRICK MCCLELLAN
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Credential | DSW
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Telephone | 931-244-2804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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