Individual
MACKENSIE N/A BLU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT
Contact information
Practice address
826 MEMORIAL AVE, MACKENSIE BLU, MURFREESBORO, TN 37130
(615) 542-5068
Mailing address
POBOX95, MACKENSIE BLU, WOODBURY AVE, TN 37190
(615) 542-5068
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
260
TN
101YA0400X
Addiction (Substance Use Disorder) Counselor
260
TN
101YM0800X
Mental Health Counselor
260
TN
106H00000X
Marriage & Family Therapist
Primary
260
TN
171M00000X
Case Manager/Care Coordinator
260
TN
Other
Enumeration date
09/17/2010
Last updated
09/17/2010
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