Healthcare Provider Details

I. General information

NPI: 1366334146
Provider Name (Legal Business Name): STABLE SPACE TRAUMA AND EQUINE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9580 S LICK CREEK RD
LYLES TN
37098-3015
US

IV. Provider business mailing address

9580 S LICK CREEK RD
LYLES TN
37098-3015
US

V. Phone/Fax

Practice location:
  • Phone: 615-295-6889
  • Fax:
Mailing address:
  • Phone: 615-295-6889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RACHEL ANN SCOTT
Title or Position: THERAPIST
Credential: LPC-MHSP
Phone: 615-295-6889