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General NPI Number Information
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NPI Number | 1801161708
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Entity Type | Organization
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Legal Business Name | VANDERBILT UNIVERSITY MEDICAL CENTER
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Dates
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Enumeration Date | 03/12/2012
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Last Update Date | 03/12/2012
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Provider Practice Location Address
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Address Line | 1500 21ST AVE S SUITE 2200
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City | NASHVILLE
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State | TN
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Zip | 37212-3160
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Country | US
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Telephone | 615-343-9669
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Fax | 615-322-1578
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Provider Business Mailing Address
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Address Line | 1500 21ST AVE S SUITE 2200
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City | NASHVILLE
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State | TN
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Zip | 37212-3160
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Country | US
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Telephone | 615-343-9669
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Fax | 615-322-1578
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | MRS. BETH MARTY
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Credential | MS, LPC
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Telephone | 615-322-4257
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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 |
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License Number State |
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