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NPI Code Detail

MEDICARE: THE DEEP END LLC

MEDICARE: THE DEEP END 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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1649105966
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE DEEP END LLC
Provider Business Mailing Address
First Line : 555 MARRIOTT DR STE 315
Second Line :
City : NASHVILLE
State : TN
Zip : 37214-5088
Country : US
Telephone Number : 615-669-7157
Fax Number :
Provider Business Practice Location Address
First Line : 555 MARRIOTT DR STE 315
Second Line :
City : NASHVILLE
State : TN
Zip : 37214-5088
Country : US
Telephone Number : 615-669-7157
Fax Number :
Authorized Official
Title or Position : LICENSED PROFESSIONAL COUNSELOR
Name : JESSICA COSTALDI
Credential : LPC-MHSP
Telephone Number : 615-669-7157
Provider Enumeration Date : 06/17/2026
Last Update Date : 06/17/2026

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Directions to “THE DEEP END LLC ” Practice Location

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