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General NPI Number Information
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NPI Number | 1407341753
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Entity Type | Organization
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Legal Business Name | PHO LLC
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 100 WINNERS CIR N STE 120
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City | BRENTWOOD
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State | TN
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Zip | 37027-5012
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Country | US
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Telephone | 205-504-1587
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Fax |
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Provider Business Mailing Address
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Address Line | 6069 FRONTIER LN
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City | NASHVILLE
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State | TN
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Zip | 37211-6220
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Country | US
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Telephone | 205-504-1587
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Fax |
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Authorized Official
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Title or Position | LPC MHSP
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Name | PATRICE HELENE HINTON OSWALT
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Credential | LPC MHSP
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Telephone | 205-504-1587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MH15135
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License Number State | FL
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