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General NPI Number Information
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NPI Number | 1952726036
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Entity Type | Organization
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Legal Business Name | LANTERN LANE FARM
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Dates
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Enumeration Date | 02/26/2014
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 6201 CORINTH RD
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City | MOUNT JULIET
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State | TN
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Zip | 37122-7603
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Country | US
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Telephone | 615-584-6959
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 CORINTH RD
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City | MOUNT JULIET
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State | TN
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Zip | 37122-7603
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Country | US
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Telephone | 615-584-6959
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. RALPH COOK
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Credential | LMFT
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Telephone | 615-584-6959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5836
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License Number State | TN
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