Provider Demographics
NPI:1942055850
Name:PROVOST, KASSIE
Entity type:Individual
Prefix:
First Name:KASSIE
Middle Name:
Last Name:PROVOST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 TIGER CT
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-5192
Mailing Address - Country:US
Mailing Address - Phone:863-255-0033
Mailing Address - Fax:
Practice Address - Street 1:3326 ASPEN GROVE DR STE 275
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-4820
Practice Address - Country:US
Practice Address - Phone:615-538-0636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health