Provider Demographics
NPI:1972830677
Name:RIGHTEOUS OAKS COUNSELING
Entity Type:Organization
Organization Name:RIGHTEOUS OAKS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, MHSP
Authorized Official - Phone:615-601-2352
Mailing Address - Street 1:1609 PEPPERTREE CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1654
Mailing Address - Country:US
Mailing Address - Phone:615-601-2352
Mailing Address - Fax:615-641-6883
Practice Address - Street 1:3735 N MOUNT JULIET RD
Practice Address - Street 2:204
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3060
Practice Address - Country:US
Practice Address - Phone:615-601-2352
Practice Address - Fax:615-641-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC2454101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376955Medicare PIN