MEDICARE: MIDDLE TENNESSEE BEHAVIORAL HEALTH

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871119255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDDLE TENNESSEE BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	1922 ARLINGTON RD
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-4224
Country	:	US
Telephone Number	:	615-994-1440
Fax Number	:	615-965-2243

Provider Business Practice Location Address
First Line	:	1922 ARLINGTON RD
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-4224
Country	:	US
Telephone Number	:	615-994-1440
Fax Number	:	615-965-2243

Authorized Official
Title or Position	:	SINGLE MEMBER LLC.
Name	:	DAVID ALLEN KINZER
Credential	:	MCOUN, LPC
Telephone Number	:	615-994-1440

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	06/22/2020

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