Healthcare Provider Details

I. General information

NPI: 1861875908
Provider Name (Legal Business Name): WHETSTONE VALLEY STABLES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3368 MURPHY LN
COLUMBIA TN
38401-5741
US

IV. Provider business mailing address

3370 MURPHY LN
COLUMBIA TN
38401-5741
US

V. Phone/Fax

Practice location:
  • Phone: 931-215-6863
  • Fax: 931-381-2896
Mailing address:
  • Phone: 931-215-6863
  • Fax: 931-381-2896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number14516
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number14516
License Number StateTN

VIII. Authorized Official

Name: MRS. PENNY JO SHOUP
Title or Position: OWNER
Credential: RN EQUINE SPECIALIST
Phone: 931-215-6863