MEDICARE: DANQUILLA TOWNSEND OWNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	I000000039646	TN
2	261QM0850X	Adult Mental Health Clinic/Center	I000000039646	TN
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	I000000039646	TN
4	261QM0855X	Adolescent and Children Mental Health Clinic/Center	I000000039646	TN

General Provider Information

NPI Number	:	1104662428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANQUILLA TOWNSEND OWNER

Provider Business Mailing Address
First Line	:	2874 PRICE DR STE 2
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-4695
Country	:	US
Telephone Number	:	901-428-2905
Fax Number	:	833-829-5135

Provider Business Practice Location Address
First Line	:	2874 PRICE DR STE 2
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-4695
Country	:	US
Telephone Number	:	901-428-2905
Fax Number	:	833-829-5135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2024
Last Update Date	:	03/03/2026

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