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General NPI Number Information
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NPI Number | 1457971087
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Entity Type | Organization
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Legal Business Name | CLOVER MENTAL HEALTH LLC
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Dates
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Enumeration Date | 04/23/2020
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 135 QUITA CIR APT B
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City | LEBANON
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State | TN
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Zip | 37087-4440
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Country | US
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Telephone | 615-955-1729
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Fax |
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Provider Business Mailing Address
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Address Line | 135 QUITA CIR APT B
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City | LEBANON
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State | TN
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Zip | 37087-4440
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Country | US
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Telephone | 615-955-1729
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | JUSTIN H DONNELLY
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Credential |
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Telephone | 615-955-1729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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