Basic Information
| Provider Information | |||||||||
| NPI: | 1003492562 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | A SOUND MIND BEHAVIORAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 BELLE GLEN LN | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239460044 | ||||||||
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| Practice Location | |||||||||
| Address1: | 103 CONTINENTAL PL | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370271041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154457600 | ||||||||
| FaxNumber: | 6153328939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2021 | ||||||||
| LastUpdateDate: | 03/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | LEWEY | ||||||||
| AuthorizedOfficialFirstName: | CARRIE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4239460044 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
| NPICertificationDate: | 03/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1366871030 | 05 | TN | MEDICAID |