Provider Demographics
NPI:1649706557
Name:BERNARD, IRENE Y (DMIN, LADACII, CAADC)
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:Y
Last Name:BERNARD
Suffix:
Gender:F
Credentials:DMIN, LADACII, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9725 WOODLAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6661
Mailing Address - Country:US
Mailing Address - Phone:901-378-0723
Mailing Address - Fax:
Practice Address - Street 1:9725 WOODLAND HILLS DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6661
Practice Address - Country:US
Practice Address - Phone:901-378-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC1224101Y00000X, 101YA0400X
TNLDC0000001224101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ057884Medicaid