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General NPI Number Information
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NPI Number | 1811873300
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Entity Type | Individual
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Provider Name | MISTY MANTOOTH
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Gender | Female
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | LIFESTANCE THERAPISTS & PSYCHIATRISTS BRENTWOOD 9020 OVERLOOK BLVD SUITE 130
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City | BRENTWOOD
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State | TN
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Zip | 37027
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Country | US
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Telephone | 615-905-0515
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Fax |
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Provider Business Mailing Address
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Address Line | 9020 OVERLOOK BLVD STE 130
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City | BRENTWOOD
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State | TN
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Zip | 37027-3259
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Country | US
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Telephone | 865-588-3173
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Fax | 865-312-6387
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 180015
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License Number State | TN
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