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General NPI Number Information
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NPI Number | 1205187705
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Entity Type | Organization
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Legal Business Name | TGR GROUP, LLC
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Dates
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Enumeration Date | 09/24/2012
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 5115 MARYLAND WAY
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City | BRENTWOOD
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State | TN
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Zip | 37027-1200
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Country | US
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Telephone | 615-500-4761
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Fax |
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Provider Business Mailing Address
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Address Line | 5115 MARYLAND WAY
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City | BRENTWOOD
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State | TN
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Zip | 37027-1200
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Country | US
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Telephone | 615-500-4761
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THERESE GRABLE
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Credential | LPC-MHSP
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Telephone | 615-500-4761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1866
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License Number State | TN
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