Provider Demographics
NPI:1023558897
Name:MAIN STREET INTERVENTIONS
Entity Type:Organization
Organization Name:MAIN STREET INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-740-7100
Mailing Address - Street 1:100 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-1889
Mailing Address - Country:US
Mailing Address - Phone:615-740-7100
Mailing Address - Fax:615-740-6959
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1889
Practice Address - Country:US
Practice Address - Phone:615-740-7100
Practice Address - Fax:615-740-8329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty