Provider Demographics
NPI:1962052159
Name:RICE, THEODORE ALLEN (LPC/MHSP)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:ALLEN
Last Name:RICE
Suffix:
Gender:M
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:TED
Other - Middle Name:ALLEN
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4525 HARDING PIKE STE B-210
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2119
Mailing Address - Country:US
Mailing Address - Phone:615-982-1131
Mailing Address - Fax:
Practice Address - Street 1:4525 HARDING PIKE STE B-210
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2119
Practice Address - Country:US
Practice Address - Phone:615-982-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1726101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty