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NPI Code Detail

MEDICARE: DORIS KAY BLACK LMSW

MEDICARE: DORIS KAY BLACK LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2104100000XSocial Worker12599TN
3101YM0800XMental Health CounselorTN

General Provider Information

NPI Number : 1003302175
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORIS KAY BLACK LMSW
Provider Business Mailing Address
First Line : 39 MURRAY GUARD DR
Second Line :
City : JACKSON
State : TN
Zip : 38305-3610
Country : US
Telephone Number : 731-736-4400
Fax Number :
Provider Business Practice Location Address
First Line : 39 MURRAY GUARD DR
Second Line :
City : JACKSON
State : TN
Zip : 38305-3610
Country : US
Telephone Number : 731-736-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2018
Last Update Date : 10/02/2024

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Directions to “ DORIS KAY BLACK LMSW” Practice Location

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