=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689640468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2006
-----------------------------------------------------
Last Update Date | 08/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1614 WELLINGTON GRN
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37064-5359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-794-1814
-----------------------------------------------------
Fax | 615-372-0471
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 681345
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37068-1345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-794-1814
-----------------------------------------------------
Fax | 615-372-0471
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CAROL D WHITTEN
-----------------------------------------------------
Credential | APN
-----------------------------------------------------
Telephone | 615-794-1814
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------