Provider Demographics
NPI:1760684799
Name:COUNSELING SERVICES OF MIDDLE TN, LLC
Entity Type:Organization
Organization Name:COUNSELING SERVICES OF MIDDLE TN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PADULA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:615-418-0538
Mailing Address - Street 1:PO BOX 292434
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37229-2434
Mailing Address - Country:US
Mailing Address - Phone:615-418-0538
Mailing Address - Fax:615-859-4990
Practice Address - Street 1:420 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072
Practice Address - Country:US
Practice Address - Phone:615-418-0538
Practice Address - Fax:615-859-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty