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General NPI Number Information
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NPI Number | 1174098321
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Entity Type | Organization
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Legal Business Name | INSIGHTFUL PEDIATRIC AND FAMILY THERAPY, LLC
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Dates
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Enumeration Date | 10/03/2018
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 164 CHURCHILL DR
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City | SPARTA
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State | TN
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Zip | 38583-1525
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Country | US
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Telephone | 931-246-9449
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Fax |
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Provider Business Mailing Address
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Address Line | 2158 WYND WALKER DR
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City | COOKEVILLE
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State | TN
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Zip | 38506-5698
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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 | LPC-MHSP
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Name | ISHA CHANEY
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Credential | MA, LPC-MHSP
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Telephone | 931-246-9449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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