Provider Demographics
NPI:1699274522
Name:CARLYLE COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:CARLYLE COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROF COUNSELOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILLETTE
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARLYLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MHSP
Authorized Official - Phone:931-237-4341
Mailing Address - Street 1:751 MCCLAIN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040
Mailing Address - Country:US
Mailing Address - Phone:931-237-4341
Mailing Address - Fax:931-451-1347
Practice Address - Street 1:279 CLEAR SKY CT STE D
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5946
Practice Address - Country:US
Practice Address - Phone:931-237-4341
Practice Address - Fax:931-451-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3352101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ032951Medicaid