Provider Demographics
NPI:1598251837
Name:THAYER, TOBIE (TLPC)
Entity Type:Individual
Prefix:
First Name:TOBIE
Middle Name:
Last Name:THAYER
Suffix:
Gender:F
Credentials:TLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 NORTHERN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3717
Mailing Address - Country:US
Mailing Address - Phone:423-313-4707
Mailing Address - Fax:
Practice Address - Street 1:5010 AUSTIN RD
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5175
Practice Address - Country:US
Practice Address - Phone:423-602-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4154101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional