Provider Demographics
NPI:1346493574
Name:MIDDLE TENNESSEE COUNSELING SERVICES, INC
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE COUNSELING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:LINK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:615-453-7530
Mailing Address - Street 1:435 PARK AVENUE
Mailing Address - Street 2:STALLINGS BUILDING
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3630
Mailing Address - Country:US
Mailing Address - Phone:615-453-7530
Mailing Address - Fax:615-453-7531
Practice Address - Street 1:435 PARK AVENUE
Practice Address - Street 2:STALLINGS BUILDING
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3630
Practice Address - Country:US
Practice Address - Phone:615-453-7530
Practice Address - Fax:615-453-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1496101YM0800X
TN1725103TA0400X
TN1427103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty