Provider Demographics
NPI:1235267113
Name:PRICE, TINA M
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:M
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 TWIN MARYS DR
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-6171
Mailing Address - Country:US
Mailing Address - Phone:931-454-9544
Mailing Address - Fax:
Practice Address - Street 1:4618 OLD MANCHESTER HWY
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-6745
Practice Address - Country:US
Practice Address - Phone:931-393-3485
Practice Address - Fax:931-393-2342
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor