Provider Information for 1245789791
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BRUCE THEOBALD, M.A., LPC
Organization Subpart: NO
NPI: 1245789791
Last Updated: 2016-09-26
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1245789791 | ||||||||
| Enumeration Date | 2016-09-26 | ||||||||
| NPI Type | NPI-2 Organization | ||||||||
| Status | Active | ||||||||
| Authorized Official Information | Name: Mr. BRUCE THEOBALD LPC Title: Owner Phone: 6157527625 | ||||||||
| Mailing Address | 1107 BATTLEWOOD ST FRANKLIN, TN 37069-6453 United States Phone: 615-752-7625 | Fax: | ||||||||
| Primary Practice Address | 1107 BATTLEWOOD ST FRANKLIN, TN 37069-6453 United States Phone: 615-752-7625 | Fax: | ||||||||
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