| The Starting Place, Llc | |
|
180 W. University Pkwy Suite H Jackson TN 38305-1612 | |
| (731) 499-2508 | |
| Not Available |
| Full Name | The Starting Place, Llc |
|---|---|
| Speciality | Counselor |
| Location | 180 W. University Pkwy, Jackson, Tennessee |
| Authorized Official Name and Position | Susan J Lovelace (ACCOUNTS MANAGER) |
| Authorized Official Contact | 7314450089 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Starting Place, Llc Po Box 10875 Jackson TN 38308-0114 Ph: (731) 445-0089 | The Starting Place, Llc 180 W. University Pkwy Suite H Jackson TN 38305-1612 Ph: (731) 499-2508 |
| NPI Number | 1780922393 |
|---|---|
| Provider Enumeration Date | 01/17/2013 |
| Last Update Date | 03/17/2015 |
| Medicare PECOS PAC ID | 4880848134 |
|---|---|
| Medicare Enrollment ID | O20130214000115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780922393 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | LSW0000005633 (Tennessee) | Primary |
| 1041C0700X | Social Worker - Clinical | LSW0000005633 (Tennessee) | Secondary |
| Provider Name | Stephanie R Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225288541 PECOS PAC ID: 0840456000 Enrollment ID: I20120717000164 |
| Provider Name | Diane H Wright |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407153406 PECOS PAC ID: 9739333097 Enrollment ID: I20130214000254 |
| Provider Name | Christine L Polk |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235458779 PECOS PAC ID: 4486893492 Enrollment ID: I20130625000107 |
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