MEDICARE: NEUROWELL COUNSELING LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1083208938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROWELL COUNSELING LLC

Provider Business Mailing Address
First Line	:	5625 SCENIC RIDGE DR
Second Line	:
City	:	OLD HICKORY
State	:	TN
Zip	:	37138-1325
Country	:	US
Telephone Number	:	731-697-2746
Fax Number	:

Provider Business Practice Location Address
First Line	:	5625 SCENIC RIDGE DR
Second Line	:
City	:	OLD HICKORY
State	:	TN
Zip	:	37138-1325
Country	:	US
Telephone Number	:	731-697-2746
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAUREN FIELDS
Credential	:	LCSW
Telephone Number	:	731-697-2746

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	06/18/2021

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