Provider Demographics
NPI:1245361211
Name:KISHONTHY, EDINA (MFT)
Entity type:Individual
Prefix:
First Name:EDINA
Middle Name:
Last Name:KISHONTHY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 SAVANNAH WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2630
Mailing Address - Country:US
Mailing Address - Phone:310-200-9739
Mailing Address - Fax:
Practice Address - Street 1:1604 WESTGATE CIR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1300
Practice Address - Country:US
Practice Address - Phone:615-745-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48260106H00000X
TN1588106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist