Individual
MACIE IRENE CAUDILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, MHSP
Contact information
Practice address
1330 NEAL ST STE D, COOKEVILLE, TN 38501-4307
(931) 528-6803
(931) 528-6826
Mailing address
1330 NEAL ST STE D, COOKEVILLE, TN 38501-4307
(931) 528-6803
(931) 528-6826
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0795
KY
101YM0800X
Mental Health Counselor
Primary
2311
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000367463
ANTHEM BCBS
—
05
—
30610026
—
KY
Enumeration date
09/14/2006
Last updated
07/21/2022
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