Healthcare Provider Details

I. General information

NPI: 1972702223
Provider Name (Legal Business Name): GAYLE M CRAVENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367B N PARKWAY STE 1
JACKSON TN
38305-2899
US

IV. Provider business mailing address

367B N PARKWAY STE 1
JACKSON TN
38305-2899
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-2277
  • Fax: 731-660-0510
Mailing address:
  • Phone: 731-668-2277
  • Fax: 731-660-0510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: GAYLE MICHAEL CRAVENS
Title or Position: OWNER
Credential: DR,LPC,LMFT
Phone: 731-608-3977