Healthcare Provider Details

I. General information

NPI: 1912938515
Provider Name (Legal Business Name): MADISON BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MEDICAL PARK DR SUITE 204
MADISON TN
37115-4253
US

IV. Provider business mailing address

600 MEDICAL PARK DR SUITE 204
MADISON TN
37115-4253
US

V. Phone/Fax

Practice location:
  • Phone: 615-860-6500
  • Fax:
Mailing address:
  • Phone: 615-860-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CHUCK LOCKE
Title or Position: VP
Credential:
Phone: 615-860-6500