Healthcare Provider Details

I. General information

NPI: 1689077802
Provider Name (Legal Business Name): LEMAI DAISY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1473 MUTUAL DR
CLARKSVILLE TN
37042-7090
US

IV. Provider business mailing address

1473 MUTUAL DR
CLARKSVILLE TN
37042-7090
US

V. Phone/Fax

Practice location:
  • Phone: 800-341-8864
  • Fax:
Mailing address:
  • Phone: 800-341-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. INGRID LEMAI JACKSON
Title or Position: OWNER
Credential: M.ED.
Phone: 615-484-1642