Provider Demographics
NPI:1467592956
Name:KINNAMAN, RICHARD TERRY (LICENSED ALCOHOL DRU)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:TERRY
Last Name:KINNAMAN
Suffix:
Gender:M
Credentials:LICENSED ALCOHOL DRU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 HARRAH DR. SUITE M
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174
Mailing Address - Country:US
Mailing Address - Phone:615-812-9773
Mailing Address - Fax:615-302-0108
Practice Address - Street 1:3011 HARRAH DR. SUITE M
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174
Practice Address - Country:US
Practice Address - Phone:615-812-9773
Practice Address - Fax:615-302-0108
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN407101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)