Provider Demographics
NPI:1255442794
Name:MENTAL HEALTH CENTERS & CLINICS OF TENNESSEE
Entity type:Organization
Organization Name:MENTAL HEALTH CENTERS & CLINICS OF TENNESSEE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEDLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-658-6113
Mailing Address - Street 1:10710 OLD HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-3587
Mailing Address - Country:US
Mailing Address - Phone:731-658-6113
Mailing Address - Fax:731-658-6165
Practice Address - Street 1:10710 OLD HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-3587
Practice Address - Country:US
Practice Address - Phone:731-658-6113
Practice Address - Fax:731-658-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
TNL 214-076-6309101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3706936Medicaid
TN2008479OtherBCBS
TN2008479OtherBCBS