Provider Demographics
NPI:1003299694
Name:HATLEY, TONY (LPC/MHSP)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:HATLEY
Suffix:
Gender:M
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 HARBOR CIR
Mailing Address - Street 2:
Mailing Address - City:NEW JOHNSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37134-9637
Mailing Address - Country:US
Mailing Address - Phone:731-220-2919
Mailing Address - Fax:
Practice Address - Street 1:26 LAMAR CIR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-4121
Practice Address - Country:US
Practice Address - Phone:731-220-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3398101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional