Individual
MIKE MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
165 BELLE FOREST CIR STE A, NASHVILLE, TN 37221-2174
(615) 852-5272
Mailing address
2708 MOODY RD, CLARKSVILLE, TN 37040-7302
(615) 982-9232
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1302
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1302
STATE OF TENNESSEE
TN
Enumeration date
09/10/2019
Last updated
09/10/2019
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