Healthcare Provider Details

I. General information

NPI: 1588138200
Provider Name (Legal Business Name): KAIROS MENTAL HEALTH COOPERATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 ELM HILL PIKE STE 250
NASHVILLE TN
37210-4579
US

IV. Provider business mailing address

3945 STILTON DR
NASHVILLE TN
37207-1630
US

V. Phone/Fax

Practice location:
  • Phone: 615-613-7639
  • Fax:
Mailing address:
  • Phone: 615-589-1018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: EBONI NICOLE WEBB
Title or Position: OWNER
Credential: PSYD
Phone: 615-589-1018