Healthcare Provider Details

I. General information

NPI: 1235947474
Provider Name (Legal Business Name): TENNESSEE MENTAL WELLNESS PREMIUM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 NASHVILLE PIKE
GALLATIN TN
37066-3165
US

IV. Provider business mailing address

1185 NASHVILLE PIKE
GALLATIN TN
37066-3165
US

V. Phone/Fax

Practice location:
  • Phone: 615-510-4551
  • Fax:
Mailing address:
  • Phone: 615-510-4551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EMILY RUNYAN
Title or Position: OWNER
Credential: LMFT
Phone: 615-636-1651