Conny Archambault
Individual provider Active NPI Counselor · Tennessee Ridge, TN
NPI 1164860698 · NPPES record last updated Jun 6, 2013
Key facts
- NPI
- 1164860698
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 1330 N Main St
Tennessee Ridge, TN 37178-4003 - Phone
- (193) 172-1331
- NPI assigned
- Jun 6, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
1330 N Main St
Tennessee Ridge, TN 37178-4003
Mailing address
1330 N Main St
Tennessee Ridge, TN 37178-4003
Phone (193) 172-1331
Other providers in Tennessee Ridge, TN
All providers in Tennessee Ridge, TN · Counselor in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.