Provider Demographics
NPI:1215791090
Name:VIVIO, CALEB KENNETH (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:KENNETH
Last Name:VIVIO
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7556 US HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-2686
Mailing Address - Country:US
Mailing Address - Phone:901-552-3497
Mailing Address - Fax:574-635-9228
Practice Address - Street 1:109 TUCKER ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-4092
Practice Address - Country:US
Practice Address - Phone:731-203-1584
Practice Address - Fax:574-635-9228
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5554101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health