Healthcare Provider Details

I. General information

NPI: 1619160090
Provider Name (Legal Business Name): SABIN BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 PRESIDENT PL STE 202
SMYRNA TN
37167-5681
US

IV. Provider business mailing address

695 PRESIDENT PL STE 202
SMYRNA TN
37167-5681
US

V. Phone/Fax

Practice location:
  • Phone: 615-269-4990
  • Fax: 615-953-9862
Mailing address:
  • Phone: 615-269-4990
  • Fax: 615-953-9862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number29
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2601
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberP248
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4362
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW4894
License Number StateTN

VIII. Authorized Official

Name: JESSICA ELAINE HUDDLESTON
Title or Position: OPERATIONS DIRECTOR
Credential: MA, MCJ
Phone: 615-269-4990