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General NPI Number Information
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NPI Number | 1982012423
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Entity Type | Individual
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Provider Name | SAMUEL R. SCALES LPC-MHSP
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Gender | Male
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 08/02/2019
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Provider Practice Location Address
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Address Line | 1916 PATTERSON ST STE 504
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City | NASHVILLE
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State | TN
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Zip | 37203-2181
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Country | US
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Telephone | 615-285-9119
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Fax |
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Provider Business Mailing Address
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Address Line | 4546 ARTELIA DR
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City | ANTIOCH
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State | TN
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Zip | 37013-2721
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Country | US
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Telephone | 615-500-8223
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2443
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 002443
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2443
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License Number State | TN
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