MEDICARE: FAMILY RECONCILIATION CENTER

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	2835	TN

General Provider Information

NPI Number	:	1588115950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY RECONCILIATION CENTER

Provider Business Mailing Address
First Line	:	6300 CHARLOTTE PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-2927
Country	:	US
Telephone Number	:	615-554-5075
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 CHARLOTTE PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-2927
Country	:	US
Telephone Number	:	615-554-5075
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. MALINDA DAVENPORT CRISP
Credential	:	LPC/MHSP
Telephone Number	:	615-554-5075

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	10/20/2016

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