Healthcare Provider Details

I. General information

NPI: 1952629198
Provider Name (Legal Business Name): LIFEWORKS BEHAVIORAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 MURRAY GUARD DR SUITE B
JACKSON TN
38305-3742
US

IV. Provider business mailing address

174 MURRAY GUARD DR SUITE B
JACKSON TN
38305-3742
US

V. Phone/Fax

Practice location:
  • Phone: 731-660-0199
  • Fax: 731-660-3650
Mailing address:
  • Phone: 731-660-0199
  • Fax: 731-660-3650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC813
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC2718
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN11898
License Number StateTN

VIII. Authorized Official

Name: MR. PERRY B PRATT
Title or Position: OWNER
Credential: LPC/MHSP
Phone: 731-660-0199