=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326114299
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VANDERBILT COMMUNITY MENTAL HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 23RD AVE S FL 3
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37212-3133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-532-5400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5764 AMALIE DR
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37211-5993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-333-0592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MENTAL HEALTH CLINICIAN 2
-----------------------------------------------------
Name | MS. CYNTHIA NICOLE BAILEY
-----------------------------------------------------
Credential | CMSW
-----------------------------------------------------
Telephone | 615-532-5400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------