Healthcare Provider Details

I. General information

NPI: 1871797704
Provider Name (Legal Business Name): COMPREHENSIVE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384D CARRIAGE HOUSE DRIVE
JACKSON TN
38305-2268
US

IV. Provider business mailing address

384D CARRIAGE HOUSE DRIVE
JACKSON TN
38305-2268
US

V. Phone/Fax

Practice location:
  • Phone: 731-256-2006
  • Fax: 731-256-2007
Mailing address:
  • Phone: 731-256-2006
  • Fax: 731-256-2007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN0000108574
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberRN0000108574
License Number StateTN

VIII. Authorized Official

Name: BRIAN G BROWN
Title or Position: OWNER
Credential:
Phone: 731-256-2006