MEDICARE: INVICTA SERVICES GROUP

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1033835251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INVICTA SERVICES GROUP

Provider Business Mailing Address
First Line	:	334 46TH AVE N
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-3451
Country	:	US
Telephone Number	:	615-830-4964
Fax Number	:	888-582-6074

Provider Business Practice Location Address
First Line	:	334 46TH AVE N
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-3451
Country	:	US
Telephone Number	:	615-830-4964
Fax Number	:	888-582-6074

Authorized Official
Title or Position	:	CLINICAL
Name	:	DR. RICHARD RAYMOND CURRAN
Credential	:	PHD
Telephone Number	:	615-830-4964

Provider Enumeration Date	:	10/19/2022
Last Update Date	:	03/28/2023

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