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General NPI Number Information
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NPI Number | 1669104311
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Entity Type | Organization
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Legal Business Name | YOUR TENNESSEE COUNSELOR, PLLC
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 109 E SOUTH ST
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City | COLLIERVILLE
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State | TN
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Zip | 38017-3018
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Country | US
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Telephone | 901-647-0540
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Fax |
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Provider Business Mailing Address
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Address Line | 30 MALLARD LN
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City | ROSSVILLE
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State | TN
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Zip | 38066-1505
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Country | US
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Telephone | 901-647-0540
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAUREN ASHLEY
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Credential | LPC-MHSP
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Telephone | 901-647-0540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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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