Provider Demographics
NPI:1386175545
Name:SERENITY COUNSELING & MEDIATION CENTER
Entity type:Organization
Organization Name:SERENITY COUNSELING & MEDIATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICEER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-527-3060
Mailing Address - Street 1:563 S WATER AVE STE E
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-6312
Mailing Address - Country:US
Mailing Address - Phone:615-527-3060
Mailing Address - Fax:
Practice Address - Street 1:563 S WATER AVE STE E
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6312
Practice Address - Country:US
Practice Address - Phone:615-527-3060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty