Provider Demographics
NPI:1235568858
Name:CLARKSVILLE THERAPY PROFESSIONALS, LLC.
Entity Type:Organization
Organization Name:CLARKSVILLE THERAPY PROFESSIONALS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-919-3833
Mailing Address - Street 1:PO BOX 31842
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-0031
Mailing Address - Country:US
Mailing Address - Phone:931-919-3833
Mailing Address - Fax:
Practice Address - Street 1:1552 APACHE WAY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-8178
Practice Address - Country:US
Practice Address - Phone:931-919-3833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4105252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency