Provider Demographics
NPI:1801161708
Name:VANDERBILT UNIVERSITY MEDICAL CENTER
Entity type:Organization
Organization Name:VANDERBILT UNIVERSITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:615-322-4257
Mailing Address - Street 1:1500 21ST AVE S
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-3160
Mailing Address - Country:US
Mailing Address - Phone:615-343-9669
Mailing Address - Fax:615-322-1578
Practice Address - Street 1:1500 21ST AVE S
Practice Address - Street 2:SUITE 2200
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3160
Practice Address - Country:US
Practice Address - Phone:615-343-9669
Practice Address - Fax:615-322-1578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty