MEDICARE: DEBRA SUSAN NASH LCSW

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	1041C0700X	Clinical Social Worker	LSW0000003905	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780789289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA SUSAN NASH LCSW

Provider Business Mailing Address
First Line	:	386 CARRIAGE HOUSE DR STE E
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-2236
Country	:	US
Telephone Number	:	731-217-9340
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 OLD HICKORY BLVD STE E
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-2911
Country	:	US
Telephone Number	:	731-660-6402
Fax Number	:

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/06/2015

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