Provider Demographics
NPI:1467222315
Name:SEIGLER, DERRELL THOMAS JR (LPC-MHSP, MA, NCC)
Entity Type:Individual
Prefix:MR
First Name:DERRELL
Middle Name:THOMAS
Last Name:SEIGLER
Suffix:JR
Gender:M
Credentials:LPC-MHSP, MA, NCC
Other - Prefix:MR
Other - First Name:DERRELL
Other - Middle Name:T
Other - Last Name:SEIGLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-MHSP, MA, NCC
Mailing Address - Street 1:4745 CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-4111
Mailing Address - Country:US
Mailing Address - Phone:615-339-8595
Mailing Address - Fax:
Practice Address - Street 1:4745 CASCADE DR
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-4111
Practice Address - Country:US
Practice Address - Phone:615-339-8595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5478101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional