Provider Demographics
NPI:1164504205
Name:WIGGINS, TODD (LPE)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3636
Mailing Address - Country:US
Mailing Address - Phone:615-278-2241
Mailing Address - Fax:615-904-9182
Practice Address - Street 1:1855 EXECUTIVE PARK NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2735
Practice Address - Country:US
Practice Address - Phone:423-479-5454
Practice Address - Fax:423-479-0403
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health