Healthcare Provider Details

I. General information

NPI: 1801249347
Provider Name (Legal Business Name): BRANDY URBAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E WOOD ST
PARIS TN
38242-7990
US

IV. Provider business mailing address

2555 E WOOD ST
PARIS TN
38242-7990
US

V. Phone/Fax

Practice location:
  • Phone: 731-641-4545
  • Fax: 731-641-4546
Mailing address:
  • Phone: 731-641-4545
  • Fax: 731-641-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: