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General NPI Number Information
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NPI Number | 1548793441
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Entity Type | Organization
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Legal Business Name | STONEBRIDGE FAMILY COUNSELING
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 209 EDISON ST E
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-3007
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Country | US
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Telephone | 615-516-3825
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Fax |
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Provider Business Mailing Address
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Address Line | 209 EDISON ST E
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-3007
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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 | OWNER
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Name | ANDREW LYON
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Credential | MMFT
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Telephone | 615-516-3825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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