Provider Demographics
NPI:1255491247
Name:CANTRELL, MISTY (BS)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SANDSTONE CIR STE C
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2091
Mailing Address - Country:US
Mailing Address - Phone:731-668-6886
Mailing Address - Fax:731-668-3045
Practice Address - Street 1:36 SANDSTONE CIR STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2091
Practice Address - Country:US
Practice Address - Phone:731-668-6886
Practice Address - Fax:731-668-3045
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor