Provider Demographics
NPI:1609326032
Name:HART, JOHN BENTON (DMIN, LMFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BENTON
Last Name:HART
Suffix:
Gender:M
Credentials:DMIN, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LANNOM CIR
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2434
Mailing Address - Country:US
Mailing Address - Phone:931-563-7963
Mailing Address - Fax:
Practice Address - Street 1:108 LANNOM CIR
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2434
Practice Address - Country:US
Practice Address - Phone:931-563-7963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLMT0000001213106H00000X
IN35000165A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist