Provider Demographics
NPI:1528096062
Name:CRODY, JOHN DUANE (NCC LPC-MHSP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DUANE
Last Name:CRODY
Suffix:
Gender:M
Credentials:NCC LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1204
Mailing Address - Country:US
Mailing Address - Phone:931-520-3146
Mailing Address - Fax:
Practice Address - Street 1:67 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3371
Practice Address - Country:US
Practice Address - Phone:931-520-3146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2035101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional