Provider Demographics
NPI:1790087450
Name:TREE OF LIFE MEDICAL AND COUNSELING CENTER
Entity Type:Organization
Organization Name:TREE OF LIFE MEDICAL AND COUNSELING CENTER
Other - Org Name:TLMCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIDOLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MELVILLE-CHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:615-473-2611
Mailing Address - Street 1:1215 CHICKASAW DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7427
Mailing Address - Country:US
Mailing Address - Phone:615-473-2611
Mailing Address - Fax:
Practice Address - Street 1:2014 FAIRVIEW BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062-9413
Practice Address - Country:US
Practice Address - Phone:615-473-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health