Provider Demographics
NPI:1699286963
Name:STILES, LUCINDA VICTORIA (LMFT)
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:VICTORIA
Last Name:STILES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 SUMMERTOWN HWY
Mailing Address - Street 2:
Mailing Address - City:HOHENWALD
Mailing Address - State:TN
Mailing Address - Zip Code:38462-5703
Mailing Address - Country:US
Mailing Address - Phone:931-796-5916
Mailing Address - Fax:931-796-1288
Practice Address - Street 1:912 SUMMERTOWN HWY
Practice Address - Street 2:
Practice Address - City:HOHENWALD
Practice Address - State:TN
Practice Address - Zip Code:38462-5703
Practice Address - Country:US
Practice Address - Phone:931-796-5916
Practice Address - Fax:931-796-1288
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLMT1891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2910854Medicaid