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1437 N Washington Ave Cookeville TN 38501-1439 | |
| (931) 372-9915 | |
| (931) 372-0893 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1437 N Washington Ave, Cookeville, Tennessee |
| Authorized Official Name and Position | Annette Gallardo (CLINICAL DIRECTOR) |
| Authorized Official Contact | 9313729915 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1437 N Washington Ave Cookeville TN 38501-1439 Ph: (931) 372-9915 | 1437 N Washington Ave Cookeville TN 38501-1439 Ph: (931) 372-9915 |
| NPI Number | 1649576505 |
|---|---|
| Provider Enumeration Date | 02/09/2011 |
| Last Update Date | 06/06/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649576505 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 2453 (Tennessee) | Primary |
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