MEDICARE: ALISHA M IRBY M.S.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0	OTHER		NA

General Provider Information

NPI Number	:	1538653274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISHA M IRBY M.S.

Provider Business Mailing Address
First Line	:	505 TALL TREES LN
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-5146
Country	:	US
Telephone Number	:	615-290-2775
Fax Number	:

Provider Business Practice Location Address
First Line	:	4235 HILLSBORO PIKE STE 239
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-3344
Country	:	US
Telephone Number	:	615-290-2775
Fax Number	:

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

Provider Enumeration Date	:	06/17/2018
Last Update Date	:	06/17/2018

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