Healthcare Provider Details

I. General information

NPI: 1932961620
Provider Name (Legal Business Name): MAMAYA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VANTAGE WAY STE E130
NASHVILLE TN
37228-1591
US

IV. Provider business mailing address

1 VANTAGE WAY STE E130
NASHVILLE TN
37228-1591
US

V. Phone/Fax

Practice location:
  • Phone: 615-988-4763
  • Fax: 615-285-8056
Mailing address:
  • Phone: 615-988-4763
  • Fax: 615-285-8056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMY LYNN GREEN
Title or Position: CEO
Credential: LCSW
Phone: 225-281-5049