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General NPI Number Information
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NPI Number | 1649576505
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Entity Type | Organization
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Legal Business Name | FAMILY COUNSELING INC
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 06/06/2014
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Provider Practice Location Address
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Address Line | 1437 N WASHINGTON AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-1439
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Country | US
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Telephone | 931-372-9915
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Fax | 931-372-0893
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Provider Business Mailing Address
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Address Line | 1437 N WASHINGTON AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-1439
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Country | US
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Telephone | 931-372-9915
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Fax | 931-372-0893
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | ANNETTE GALLARDO
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Credential | LPC
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Telephone | 931-372-9915
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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 | 2453
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License Number State | TN
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