Provider Demographics
NPI:1760568877
Name:CAREY COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:CAREY COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-642-0521
Mailing Address - Street 1:408 VIRGINIA ST
Mailing Address - Street 2:P.O. BOX 30
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5341
Mailing Address - Country:US
Mailing Address - Phone:731-644-1753
Mailing Address - Fax:731-642-1010
Practice Address - Street 1:408 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5341
Practice Address - Country:US
Practice Address - Phone:731-644-1753
Practice Address - Fax:731-642-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000225101YA0400X
TNL2(14)M2-076-6265101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3399964Medicare ID - Type Unspecified
3399962Medicare PIN
TN3923672Medicare PIN