Provider Demographics
NPI:1083742084
Name:CENTERSTONE
Entity Type:Organization
Organization Name:CENTERSTONE
Other - Org Name:MENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW
Authorized Official - Phone:615-463-6629
Mailing Address - Street 1:704 HIGHWAY 100
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:CENTERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37033-1171
Mailing Address - Country:US
Mailing Address - Phone:931-729-3573
Mailing Address - Fax:931-729-9330
Practice Address - Street 1:704 HIGHWAY 100
Practice Address - Street 2:SUITE101
Practice Address - City:CENTERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37033
Practice Address - Country:US
Practice Address - Phone:931-729-3573
Practice Address - Fax:931-729-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0000000235251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health