Provider Demographics
NPI:1861665093
Name:NASH, LEON MANUEL III
Entity Type:Individual
Prefix:MR
First Name:LEON
Middle Name:MANUEL
Last Name:NASH
Suffix:III
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:TREY
Other - Middle Name:MANUEL
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:945 CLEVELAND STREET
Mailing Address - Street 2:APT E-12
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38488
Mailing Address - Country:US
Mailing Address - Phone:931-560-4220
Mailing Address - Fax:931-560-4221
Practice Address - Street 1:115 DYER STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-560-4220
Practice Address - Fax:931-560-4221
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health