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General NPI Number Information
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NPI Number | 1295363182
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Entity Type | Organization
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Legal Business Name | THE PRATT CLINIC, PLLC
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Dates
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Enumeration Date | 03/28/2020
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 168 W UNIVERSITY PKWY
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City | JACKSON
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State | TN
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Zip | 38305-1624
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Country | US
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Telephone | 731-660-0199
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Fax | 731-227-6116
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Provider Business Mailing Address
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Address Line | 162 ROLLING OAKS DR
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City | HUMBOLDT
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State | TN
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Zip | 38343-8585
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Country | US
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Telephone | 731-803-4652
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Fax | 731-227-6116
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Authorized Official
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Title or Position | OWNER
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Name | PERRY BOLTON PRATT
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Credential | PHD, LPC/MHSP
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Telephone | 731-803-4652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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