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General NPI Number Information
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NPI Number | 1518619451
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Entity Type | Individual
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Provider Name | CODY DEWAYNE YORK LPC-MHSP
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Gender | Male
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 8 S MADISON AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-3357
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Country | US
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Telephone | 931-330-0514
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Fax |
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Provider Business Mailing Address
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Address Line | 599 OAKLEY ALLONS RD
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City | ALLONS
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State | TN
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Zip | 38541-6921
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Country | US
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Telephone | 931-239-5608
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5182
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License Number State | TN
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