=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992833115
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTERSTONE COMMUNITY MENTAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 633 THOMPSON LN
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37204-3616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-460-4430
-----------------------------------------------------
Fax | 615-460-4433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 633 THOMPSON LN
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37204-3616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-460-4430
-----------------------------------------------------
Fax | 615-460-4433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL ASSISTANT
-----------------------------------------------------
Name | WANDA GAYLE MCCLOUD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-460-4461
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------