Provider Demographics
NPI:1760243406
Name:ANTHONY, MARY KATHERINE (MFT (TEMP))
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MFT (TEMP)
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:ANTHONY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1235 SPRUELL DR
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-2990
Mailing Address - Country:US
Mailing Address - Phone:423-400-0112
Mailing Address - Fax:
Practice Address - Street 1:570 BAKERS BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6456
Practice Address - Country:US
Practice Address - Phone:615-436-0921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2390106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist