Doctor Name: | TONY HATLEY |
NPI Number: | 1003299694 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC/MHSP |
License Number: | 3398 |
Business Practice Address: | 26 Lamar Cir Jackson, TN - 383054121 |
Business Phone Number: | 7312202919 |
Business Fax Number: | |
Mailing Address: | 173 Harbor Cir, NEW JOHNSONVILLE |
State: | TN |
Postal Code: | 371349637 |
Phone Number: | 7312202919 |
Fax Number: | |
NPI Enumeration Date: | 07/01/2015 |
NPI Last Update Date: | 07/01/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 3398 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |