Basic Information
| Provider Information | |||||||||
| NPI: | 1588035240 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTERSTONE OF TENNESSEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1820 MEMORIAL CIR | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370434539 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1820 MEMORIAL CIR | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370434539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9319207241 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2015 | ||||||||
| LastUpdateDate: | 10/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | MERRIAM | ||||||||
| AuthorizedOfficialFirstName: | KARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL SUPERVISOR, MOBILE CRISIS | ||||||||
| AuthorizedOfficialTelephone: | 9319207241 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.