Provider Demographics
NPI:1083872337
Name:MINTON, VIVIAN L (LPC, MHSP)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:L
Last Name:MINTON
Suffix:
Gender:F
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 1:620 OLD HICKORY BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2904
Mailing Address - Country:US
Mailing Address - Phone:731-217-0949
Mailing Address - Fax:
Practice Address - Street 1:620 OLD HICKORY BLVD STE 204
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2904
Practice Address - Country:US
Practice Address - Phone:731-217-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001857101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health