Provider Demographics
NPI:1174965420
Name:CLARKSVILLE BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:CLARKSVILLE BEHAVIORAL HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEMETRICE
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-494-7131
Mailing Address - Street 1:298 WARFIELD BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1828
Mailing Address - Country:US
Mailing Address - Phone:931-494-7131
Mailing Address - Fax:888-643-6070
Practice Address - Street 1:298 WARFIELD BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-1828
Practice Address - Country:US
Practice Address - Phone:931-494-7131
Practice Address - Fax:888-643-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1942103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
103I688906Medicare UPIN