1174712566 NPI number — MS. ROSEMARY GRACE SARVER LPC/MHSP

Table of content: MS. ROSEMARY GRACE SARVER LPC/MHSP (NPI 1174712566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174712566 NPI number — MS. ROSEMARY GRACE SARVER LPC/MHSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARVER
Provider First Name:
ROSEMARY
Provider Middle Name:
GRACE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC/MHSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174712566
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
603 LINDBERGH DR
Provider Second Line Business Mailing Address:
APT A
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37090-4030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-298-1845
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 LINDBERGH DR
Provider Second Line Business Practice Location Address:
APT A
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37090-4030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-298-1845
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  2206 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 0962 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12014791 . This is a "CAQH PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1516397 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4249519 . This is a "BCBST" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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