Ethan Cole Spicer
Individual provider Active NPI Mental Health Counselor · Tennessee Ridge, TN
NPI 1740788959 · NPPES record last updated Jan 23, 2018
Key facts
- NPI
- 1740788959
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 1330 N Main St
Tennessee Ridge, TN 37178-4003 - Phone
- (931) 721-3312
- NPI assigned
- Jan 23, 2018
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 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 (931) 721-3312
Other providers in Tennessee Ridge, TN
- Barbara E Scott
- Torrey Seay
- Amanda Dawn Self
- Olivia Faith Sims
- Jodi Lynn Smith
- Louise Agnes Turner
- Vicki Gayle Webb
- Deborah Wood
- Susan Linn Woood
- Suzanna Diane Wright
All providers in Tennessee Ridge, TN · Mental Health 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 Jan 23, 2018. 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.