Provider Demographics
NPI:1174098321
Name:INSIGHTFUL PEDIATRIC AND FAMILY THERAPY, LLC
Entity type:Organization
Organization Name:INSIGHTFUL PEDIATRIC AND FAMILY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC-MHSP
Authorized Official - Prefix:
Authorized Official - First Name:ISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-MHSP
Authorized Official - Phone:931-246-9449
Mailing Address - Street 1:2158 WYND WALKER DR
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5698
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:164 CHURCHILL DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1525
Practice Address - Country:US
Practice Address - Phone:931-246-9449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)