Provider Demographics
NPI:1215682158
Name:CLARKSVILLE COLLABORATIVE COUNSELING LLC
Entity type:Organization
Organization Name:CLARKSVILLE COLLABORATIVE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:931-271-4632
Mailing Address - Street 1:1651 WILMA RUDOLPH BLVD # 205
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6783
Mailing Address - Country:US
Mailing Address - Phone:931-271-4632
Mailing Address - Fax:931-208-3457
Practice Address - Street 1:1651 WILMA RUDOLPH BLVD # 205
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6783
Practice Address - Country:US
Practice Address - Phone:931-271-4632
Practice Address - Fax:931-208-3457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health