MEDICARE: THE CHILD AND FAMILY COUNSELING CENTER, PLLC

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	101Y00000X	Counselor
2	103TC0700X	Clinical Psychologist	2923	TN

General Provider Information

NPI Number	:	1316491343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHILD AND FAMILY COUNSELING CENTER, PLLC

Provider Business Mailing Address
First Line	:	16B WESTLAWN CT
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-4914
Country	:	US
Telephone Number	:	615-418-4217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1604 WESTGATE CIR
Second Line	:	SUITE 220
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-1300
Country	:	US
Telephone Number	:	615-418-4217
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST, HSP
Name	:	DR. MARY PAYNE
Credential	:	PHD
Telephone Number	:	615-418-4217

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	08/08/2016

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