Provider Demographics
NPI:1093435240
Name:ENVISION THERAPY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:ENVISION THERAPY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAWANNA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:931-321-1097
Mailing Address - Street 1:1033 SILO DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-1676
Mailing Address - Country:US
Mailing Address - Phone:931-321-1097
Mailing Address - Fax:
Practice Address - Street 1:5810 SHELBY OAKS DR STE B
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7315
Practice Address - Country:US
Practice Address - Phone:931-321-1097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health