Provider Demographics
NPI:1215477864
Name:MARKS, SHIRLEY (LADAC, LMFT, MAC)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:LADAC, LMFT, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 BARCLAY DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-1501
Mailing Address - Country:US
Mailing Address - Phone:615-262-3497
Mailing Address - Fax:
Practice Address - Street 1:431 NISSAN DR STE 202
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4365
Practice Address - Country:US
Practice Address - Phone:615-462-7392
Practice Address - Fax:615-267-0020
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0000000573101YA0400X
TNLMT0000001090106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ033210Medicaid