Provider Demographics
NPI:1295852416
Name:SKINNER, JUDITH S (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:S
Last Name:SKINNER
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:S
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5003 CLAUDE DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-9385
Mailing Address - Country:US
Mailing Address - Phone:615-477-5266
Mailing Address - Fax:615-203-0334
Practice Address - Street 1:405 UPTOWN SQ STE F
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0575
Practice Address - Country:US
Practice Address - Phone:615-477-5266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000003082101YM0800X
GALPC004206101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional