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NPI Code Detail

MEDICARE: JELESSA LASHAE CROSBY-POWELL

MEDICARE: JELESSA LASHAE CROSBY-POWELL
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
1320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1699202457
Entity Type Code : Individual
Provider Name (Legal Business Name) : JELESSA LASHAE CROSBY-POWELL
Provider Business Mailing Address
First Line : 2010 TYNEWOOD DR
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37042-5284
Country : US
Telephone Number : 618-501-7109
Fax Number :
Provider Business Practice Location Address
First Line : 2010 TYNEWOOD DR
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37042-5284
Country : US
Telephone Number : 618-501-7109
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2017
Last Update Date : 05/11/2017

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Directions to “ JELESSA LASHAE CROSBY-POWELL ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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