Provider Demographics
NPI:1699198895
Name:COUNSELING AND LEARNING CENTER OF TENNESSEE
Entity type:Organization
Organization Name:COUNSELING AND LEARNING CENTER OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:MILTICH
Authorized Official - Last Name:LYST
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:615-550-3560
Mailing Address - Street 1:109 INTERNATIONAL DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1761
Mailing Address - Country:US
Mailing Address - Phone:615-550-3560
Mailing Address - Fax:615-550-3580
Practice Address - Street 1:109 INTERNATIONAL DR
Practice Address - Street 2:SUITE 220
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1761
Practice Address - Country:US
Practice Address - Phone:615-550-3560
Practice Address - Fax:615-550-3580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2760103TC2200X
TN456032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty