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320 E Broad St Fl 2 Cookeville TN 38501-3382 | |
| (931) 219-9320 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 320 E Broad St Fl 2, Cookeville, Tennessee |
| Authorized Official Name and Position | Amanda Michelle Underwood (OWNER/THERAPIST) |
| Authorized Official Contact | 9312199320 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1030 Mitchell Ave Cookeville TN 38501-1852 Ph: (931) 219-9320 | 320 E Broad St Fl 2 Cookeville TN 38501-3382 Ph: (931) 219-9320 |
| NPI Number | 1497321053 |
|---|---|
| Provider Enumeration Date | 06/02/2021 |
| Last Update Date | 07/23/2024 |
| Certification Date | 07/23/2024 |
| Medicare PECOS PAC ID | 1153861265 |
|---|---|
| Medicare Enrollment ID | O20240904001350 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497321053 | NPI | - | NPPES |
| Q066566 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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