Basic Information
| Provider Information | |||||||||
| NPI: | 1568007557 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOODY | ||||||||
| FirstName: | KARA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC-MHSP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 ALHAMBRA CIR | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372073421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309363784 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2400 WHITE AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372042235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882914357 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2019 | ||||||||
| LastUpdateDate: | 11/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4783 | TN | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | 4783 | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.