Provider Demographics
NPI:1376308635
Name:ROUNDTREE MENTAL HEALTH GROUP PLLC
Entity Type:Organization
Organization Name:ROUNDTREE MENTAL HEALTH GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUNDTREE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-969-4271
Mailing Address - Street 1:4180 COLES FERRY PIKE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-9603
Mailing Address - Country:US
Mailing Address - Phone:615-969-4271
Mailing Address - Fax:
Practice Address - Street 1:142 PUBLIC SQUARE
Practice Address - Street 2:SUITE E, 104
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087
Practice Address - Country:US
Practice Address - Phone:615-969-4271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty