| Wild Ethos Family Counseling Inc | |
|
3148 Carrington Ln Columbia TN 38401-8642 | |
| (931) 539-0373 | |
| Not Available |
| Full Name | Wild Ethos Family Counseling Inc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 3148 Carrington Ln, Columbia, Tennessee |
| Authorized Official Name and Position | Jill Luke (SECRETARY) |
| Authorized Official Contact | 9315390373 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Ethos Family Counseling Inc Po Box 315 Thompsons Station TN 37179-0315 Ph: (931) 539-0373 | Wild Ethos Family Counseling Inc 3148 Carrington Ln Columbia TN 38401-8642 Ph: (931) 539-0373 |
| NPI Number | 1235718354 |
|---|---|
| Provider Enumeration Date | 04/06/2021 |
| Last Update Date | 04/16/2023 |
| Certification Date | 04/16/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235718354 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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