Provider Demographics
NPI:1316426596
Name:BRINK, STEVEN CLARK (LPC, MHSP)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:CLARK
Last Name:BRINK
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 1:1619 17TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2812
Mailing Address - Country:US
Mailing Address - Phone:615-356-2700
Mailing Address - Fax:615-872-2767
Practice Address - Street 1:1619 17TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2812
Practice Address - Country:US
Practice Address - Phone:615-356-2700
Practice Address - Fax:615-872-2767
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1992754139OtherEMPLOYER