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General NPI Number Information
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NPI Number | 1861875908
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Entity Type | Organization
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Legal Business Name | WHETSTONE VALLEY STABLES LLC
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 3368 MURPHY LN
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City | COLUMBIA
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State | TN
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Zip | 38401-5741
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Country | US
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Telephone | 931-215-6863
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Fax | 931-381-2896
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Provider Business Mailing Address
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Address Line | 3370 MURPHY LN
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City | COLUMBIA
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State | TN
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Zip | 38401-5741
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Country | US
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Telephone | 931-215-6863
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Fax | 931-381-2896
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PENNY JO SHOUP
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Credential | RN EQUINE SPECIALIST
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Telephone | 931-215-6863
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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 | 14516
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 14516
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License Number State | TN
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