Provider Demographics
NPI:1861970345
Name:MUKTHYALA, SUGUNA (LPCC)
Entity type:Individual
Prefix:
First Name:SUGUNA
Middle Name:
Last Name:MUKTHYALA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:SUGUNA
Other - Middle Name:
Other - Last Name:MUKTHYALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4914 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216-1420
Mailing Address - Country:US
Mailing Address - Phone:513-546-4398
Mailing Address - Fax:
Practice Address - Street 1:4914 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37216-1420
Practice Address - Country:US
Practice Address - Phone:513-546-4398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004987101YP2500X
TN7485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional