MEDICARE: AILEEN-ELIZABETH HERALD LCSW

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
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker	6059	TN

General Provider Information

NPI Number	:	1033460043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AILEEN-ELIZABETH HERALD LCSW

Provider Business Mailing Address
First Line	:	5923 WILLOW SPRINGS DR
Second Line	:
City	:	MILLINGTON
State	:	TN
Zip	:	38053-8437
Country	:	US
Telephone Number	:	901-616-9282
Fax Number	:

Provider Business Practice Location Address
First Line	:	5923 WILLOW SPRINGS DR
Second Line	:
City	:	MILLINGTON
State	:	TN
Zip	:	38053-8437
Country	:	US
Telephone Number	:	901-310-5880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2012
Last Update Date	:	06/29/2022

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