Provider Demographics
NPI:1417645128
Name:MAEDA, KACIE RIEA (MA, LPC-MHSP TEMP)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:RIEA
Last Name:MAEDA
Suffix:
Gender:F
Credentials:MA, LPC-MHSP TEMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21000 MIDDLETON CIR APT 21107
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1839
Mailing Address - Country:US
Mailing Address - Phone:931-319-8963
Mailing Address - Fax:
Practice Address - Street 1:4721 TROUSDALE DR STE 116
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1330
Practice Address - Country:US
Practice Address - Phone:615-447-8054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4946101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health