Provider Demographics
NPI:1295363182
Name:THE PRATT CLINIC, INC.
Entity Type:Organization
Organization Name:THE PRATT CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNTER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:BOLTON
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC/MHSP
Authorized Official - Phone:731-803-4652
Mailing Address - Street 1:162 ROLLING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-8585
Mailing Address - Country:US
Mailing Address - Phone:731-803-4652
Mailing Address - Fax:731-227-6116
Practice Address - Street 1:174 MURRAY GUARD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3742
Practice Address - Country:US
Practice Address - Phone:731-660-0199
Practice Address - Fax:731-227-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-28
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty