Provider Demographics
NPI:1871368092
Name:MINGUS, LAURIE
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:MINGUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3626
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-3626
Mailing Address - Country:US
Mailing Address - Phone:615-390-4954
Mailing Address - Fax:
Practice Address - Street 1:5722 HICKORY PLZ STE C3
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-8573
Practice Address - Country:US
Practice Address - Phone:615-431-1126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional