Provider Demographics
NPI:1093185860
Name:NASHVILLE CENTER FOR PSYCHODRAMA
Entity Type:Organization
Organization Name:NASHVILLE CENTER FOR PSYCHODRAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MENZO
Authorized Official - Middle Name:L
Authorized Official - Last Name:FAASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MHSP
Authorized Official - Phone:931-614-0439
Mailing Address - Street 1:920 KINGSBURY DR
Mailing Address - Street 2:A
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-2637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:116 WILSON PIKE CIR
Practice Address - Street 2:SUITE 106
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2706
Practice Address - Country:US
Practice Address - Phone:931-614-0439
Practice Address - Fax:615-523-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health