Provider Demographics
NPI:1013159722
Name:FITE, GAYDEN MCFARLIN (LPC-MHSP)
Entity Type:Individual
Prefix:MS
First Name:GAYDEN
Middle Name:MCFARLIN
Last Name:FITE
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 HILLMAN STREET
Mailing Address - Street 2:
Mailing Address - City:KINGSTON SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37082-9073
Mailing Address - Country:US
Mailing Address - Phone:615-440-8909
Mailing Address - Fax:
Practice Address - Street 1:359 HILLMAN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37082-9073
Practice Address - Country:US
Practice Address - Phone:615-440-8909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHICADC24077101YA0400X
TNLPC0000002151101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1512298Medicaid