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General NPI Number Information
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NPI Number | 1699198895
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Entity Type | Organization
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Legal Business Name | COUNSELING AND LEARNING CENTER OF TENNESSEE
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Dates
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Enumeration Date | 01/24/2014
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Last Update Date | 01/24/2014
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Provider Practice Location Address
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Address Line | 109 INTERNATIONAL DR SUITE 220
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City | FRANKLIN
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State | TN
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Zip | 37067-1761
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Country | US
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Telephone | 615-550-3560
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Fax | 615-550-3580
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Provider Business Mailing Address
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Address Line | 109 INTERNATIONAL DR SUITE 220
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City | FRANKLIN
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State | TN
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Zip | 37067-1761
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Country | US
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Telephone | 615-550-3560
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Fax | 615-550-3580
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. AIMEE MILTICH LYST
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Credential | PHD
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Telephone | 615-550-3560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 2760
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 45603
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License Number State | TN
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