Provider Demographics
NPI:1245959188
Name:NASHVILLE PSYCHEDELIC CENTER, LLC
Entity type:Organization
Organization Name:NASHVILLE PSYCHEDELIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DESALVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:155-608-7426
Mailing Address - Street 1:1007 TOWEE CT
Mailing Address - Street 2:
Mailing Address - City:KINGSTON SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37082-5171
Mailing Address - Country:US
Mailing Address - Phone:865-617-5110
Mailing Address - Fax:
Practice Address - Street 1:1007 TOWEE CT
Practice Address - Street 2:
Practice Address - City:KINGSTON SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37082-5171
Practice Address - Country:US
Practice Address - Phone:865-617-5110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)