| NPI | 1609162692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH B. FUSSELL Managing Partner 901-382-3888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TN LPC - 457) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: TN LMFT - 600) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2011-06-28 |