MEDICARE: EMPTY NEST 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1366117350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPTY NEST COUNSELING, LLC

Provider Business Mailing Address
First Line	:	2107 BERNARD AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-4229
Country	:	US
Telephone Number	:	615-988-5123
Fax Number	:

Provider Business Practice Location Address
First Line	:	2107 BERNARD AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-4229
Country	:	US
Telephone Number	:	615-988-5123
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EMILY PARDY
Credential	:	LMFT
Telephone Number	:	615-988-5123

Provider Enumeration Date	:	08/11/2021
Last Update Date	:	08/11/2021

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