Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 3398 | TN |
NPI | 1003299694 |
---|---|
Provider Name | Tony Hatley |
First Address | New Johnsonville, TN 37134-9637 |
Second Address | Jackson, TN 38305-4121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2015 |
Last Update Date | 01/07/2015 |