Healthcare Provider Details

I. General information

NPI: 1366553794
Provider Name (Legal Business Name): CHAISSON CREATIVE CONSULTING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 COTTON BALE CV
MEMPHIS TN
38119-8971
US

IV. Provider business mailing address

3321 COTTON BALE CV
MEMPHIS TN
38119-8971
US

V. Phone/Fax

Practice location:
  • Phone: 901-679-9458
  • Fax: 901-759-4772
Mailing address:
  • Phone: 901-679-9458
  • Fax: 901-759-4772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD J CHAISSON II
Title or Position: OWNER
Credential: BA
Phone: 901-679-9458